TY - JOUR
T1 - Right subclavian approach as a feasible alternative for transcatheter aortic valve implantation with the CoreValve ReValving System
AU - Testa, Luca
AU - Brambilla, Nedy
AU - Laudisa, Maria Luisa
AU - De Carlo, Marco
AU - Lanotte, Stefania
AU - Latini, Roberto Adriano
AU - Pizzocri, Samuele
AU - Casavecchia, Matteo
AU - Agnifili, Mauro Luca
AU - Giannini, Cristina
AU - Bortolotti, Uberto
AU - Petronio, Anna Sonia
AU - Bedogni, Francesco
PY - 2012/10
Y1 - 2012/10
N2 - Aims: Arterial access selection is crucial during transcatheter aortic valve implantation. When traditional femoral access has been deemed unfeasible the left subclavian artery has been used successfully. In cases where even the latter was ineligible, we opted, despite the lack of any data, for the right subclavian approach. We hereby present the results of the first series available. Our aim was to evaluate the feasibility and performance of the CoreValve ReValving System (CRS) implantation via the right subclavian artery in patients with contraindication to femoral and left subclavian accesses. Methods and results: Among 300 patients who have undergone CRS implantation, 70 (23%) have been treated via the subclavian approach, 10 via the right subclavian artery and 60 via the left. Demographic features were quite similar except for the presence of significant left subclavian disease in all patients treated via the right subclavian artery. The success rate was 100% for both groups. At 30-day follow-up, there was no significant difference in terms of all-cause mortality and cardiac mortality between right vs. left subclavian approach (0% vs. 6.6% and 0% vs. 6.6%, respectively). Consistent results were observed at a mean follow-up of 12±7.9 months (all-cause mortality: 10% vs. 15%). Incidences of new AV block requiring PM implantation were also statistically equivalent. Conclusions: CRS implantation via the right subclavian artery was as feasible and safe as the left subclavian approach. It poses very particular technical issues but should be considered when more conventional approaches are inadequate in order to provide patients with a further chance to be treated effectively.
AB - Aims: Arterial access selection is crucial during transcatheter aortic valve implantation. When traditional femoral access has been deemed unfeasible the left subclavian artery has been used successfully. In cases where even the latter was ineligible, we opted, despite the lack of any data, for the right subclavian approach. We hereby present the results of the first series available. Our aim was to evaluate the feasibility and performance of the CoreValve ReValving System (CRS) implantation via the right subclavian artery in patients with contraindication to femoral and left subclavian accesses. Methods and results: Among 300 patients who have undergone CRS implantation, 70 (23%) have been treated via the subclavian approach, 10 via the right subclavian artery and 60 via the left. Demographic features were quite similar except for the presence of significant left subclavian disease in all patients treated via the right subclavian artery. The success rate was 100% for both groups. At 30-day follow-up, there was no significant difference in terms of all-cause mortality and cardiac mortality between right vs. left subclavian approach (0% vs. 6.6% and 0% vs. 6.6%, respectively). Consistent results were observed at a mean follow-up of 12±7.9 months (all-cause mortality: 10% vs. 15%). Incidences of new AV block requiring PM implantation were also statistically equivalent. Conclusions: CRS implantation via the right subclavian artery was as feasible and safe as the left subclavian approach. It poses very particular technical issues but should be considered when more conventional approaches are inadequate in order to provide patients with a further chance to be treated effectively.
KW - Difficult access
KW - Right subclavian artery
KW - TAVI
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UR - http://www.scopus.com/inward/citedby.url?scp=84872138332&partnerID=8YFLogxK
U2 - 10.4244/EIJV8I6A107
DO - 10.4244/EIJV8I6A107
M3 - Article
C2 - 23086786
AN - SCOPUS:84872138332
VL - 8
SP - 685
EP - 690
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 6
ER -