Abstract 19598: Subclavian Access for CoreValve-Implantation: More Than a Bail-out Procedure?
Both femoral arteries usually are the implantation routes of first choice in patients undergoing transcatheter aortic valve implantation (TAVI). If the femoral arteries are not suitable, transapical procedures are considered. In the present literature, access via the subclavian artery is rarely described. Among 418 transarterial and transapical TAVIs performed between 2007 and 2010, the subclavian artery was chosen in 28 patients (left: 25, right. 3). 11 patients were female, mean age was 80+/−9.9 years (range: 44–92). In 19 patients, a significant coronary heart disease was present. Mean logistic Euroscore was 22.4+/−10 (range 6–46). Mean procedure time was 102+/−27 min with a mean radiation time of 21+/−6.9 min. Mean amount of contrast dye applied was 109+/−44 ml. The CoreValve-prosthesis was exclusively used. In any case, the 18-F-sheeth was introduced directly into the vessel. Procedural success was 100%. 30-day-mortality was 3.5% (ventricular rupture with tamponade), another 2 patients died late (1 myocardial deterioration, 1 sudden). Intraprocedural complications comprised malplacement with retrieval of the prosthesis and second implantation in 3 patients, a major vascular complication occurred in 1 patient. In intraoperative angiography, AI was less than 2 in 26 patients (93%). 4 patients (14%) required permanent pacemaker implantation, 1 suffered from periprocedural stroke. TAVI-implantation by the subclavian route proved to be feasible and safe with results even superior to most series of transfemoral implantations published to date. Due to the shorter distance from access site to valve annulus, placement of the valve is greatly facilitated. As we consider the subclavian access less traumatic as transapical implantation, the subclavian artery is meanwhile the second-choice implantation route in our clinical routine.
- © 2010 by American Heart Association, Inc.