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The transsubclavian and transaxillary approaches (supra- and infra-clavicular respectively) for transcatheter aortic valve replacement (TAVR) are rapidly growing alternatives in the setting of hostile iliofemoral arteries. Yet, there are few data regarding these approaches, and what data exist are largely focused on self-expanding prostheses. We sought to analyze the frequency and outcomes of patients who underwent transsubclavian or axillary TAVR (TSA-TAVR) using the Edwards LifeSciences Sapien 3 prosthesis.
The STS/ACC TVT Registry was queried for all patients undergoing TSA-TAVR with the Sapien 3 prosthesis from June 2015 (commercialization) to May 2017. The registry did not differentiate between subclavian and axillary access.
627 patients underwent TSA-TAVR at 190 US centers. 15.2% were performed using a fully percutaneous technique. The average age was 79 ± 9 years, 39% were female, and the mean STS risk score was 7.9 ± 5.7%. Unadjusted outcomes are recorded in table 1. The median number of TSA-TAVR cases per performing hospital during the study period was 2 and 44% of centers performed only 1 TSA-TAVR. Similarly, 31 of the 50 centers (62%) that performed a fully percutaneous TSA-TAVR performed only 1.
|Major vascular complications||3.1%|
|Life threatening bleeding||0.6%|
|New pacemaker implant||13.1%|
|≥ Moderate paravalvular leak||1.5%|
|30 day all-cause mortality||4.4%|
|Median length of stay||5 (IQR 3,7) days|
To date this is the largest reported cohort of TSA-TAVR patients and the only reported cohort utilizing the Sapien 3 prosthesis. The operative risks of TSA-TAVR appear very favorable despite the relatively early experience of most centers performing these cases.
STRUCTURAL: Valvular Disease: Aortic