Author + information
- Peter C. Kievit,
- Michel W. Verkroost,
- Helmut R. Gehlmann,
- Kees van der Wulp,
- Luc Noyez,
- Henri A. van Swieten,
- Harry Suryapranata and
- Menko–Jan de Boer
Vascular access for TAVI is usually obtained through the femoral route. However, many eligible patients have advanced atherosclerotic disease of the aorta and iliaco–femoral arteries, with an increased risk of vascular complications and stroke. Anatomically the left subclavian artery may be an attractive alternative for vascular access. We studied the feasibility and safety of TAVI using the left subclavian artery as primary access site.
Between December 2008 and July 2012, one hundred and twenty six consecutive patients underwent TAVI using the Medtronic CoreValve®. All procedures were performed by a dedicated cardio–thoracic surgeon and interventional cardiologist under general anaesthesia. Preoperative angiography was used to assess eligibility for left subclavian and femoral access.
The left subclavian artery was used as access site in 109 patients (87%). During the study the proportion of patients treated with this approach increased from 65% (17/26) to 92% (92/100). Of these patients, 21% had a patent LIMA graft, 5% had a left–sided pacemaker. The procedural success rate was 97%, the median procedure time 55 minutes. Thirty–day mortality was 6%, with low rates of myocardial infarction (2%) and stroke (2%). Dissection of the subclavian artery was treated with stenting in 6% of patients. The rate of major or life threatening bleeding was 13%. One–year survival was 70%.
The left subclavian artery is a feasible access site in the large majority of TAVI patients, even those with LIMA grafts or left–sided pacemakers. The procedural success rate is high, with a low risk of 30–day mortality, stroke and vascular complications. Our results show that the left subclavian approach can be developed as access site of choice for TAVI.
West, Room 2009
Monday, March 11, 2013, 9:00 a.m.–9:10 a.m.
Session Title: Transcatheter Aortic Valve Replacement (TAVR) I: Evolving Data
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2910–9
- 2013 American College of Cardiology Foundation