Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system

Anna Sonia Petronio, Marco De Carlo, Francesco Bedogni, Antonio Marzocchi, Silvio Klugmann, Francesco Maisano, Angelo Ramondo, Gian Paolo Ussia, Federica Ettori, Arnaldo Poli, Nedy Brambilla, Francesco Saia, Federico De Marco, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Background-Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. The standard retrograde approach through the femoral artery is contraindicated in case of unfavorable iliofemoral anatomy or extensive disease. In these patients, a trans-subclavian approach may be feasible. Methods and Results-Between June 2007 and July 2009, TAVI with the CoreValve bioprosthesis (Medtronic, Minneapolis, Minn) was performed in 514 consecutive patients at 13 Italian hospitals, using the subclavian approach in 54 cases. The median logistic EuroSCORE was significantly higher in the subclavian (19.4; interquartile range, 12.5 to 29.8) versus femoral group (25.3; interquartile range, 15.1 to 36.6) (P=0.03), as well as the rate of comorbidities. Procedural success was obtained in 100% versus 98.4% of the subclavian versus femoral groups, respectively (P=0.62), with intraprocedural mortality of 0% versus 0.9% (P=1.00). The most common in-hospital complications were a new left bundle-branch block (22.4%) and the need for pacemaker (16.3%). No specific complications for the subclavian access (vessel rupture, vertebral or internal mammary ischemia) were reported. The learning curve for the subclavian approach led to a wider use of local anesthesia. Thirty-day mortality was 0% versus 6.1% in the subclavian versus femoral groups, respectively (P=0.13). Six-month mortality rate was 9.4% versus 15.8% (P=0.44), whereas valve-related adverse events were 13.6% versus 13.9% (P=0.79). Conclusions-TAVI through the subclavian approach appeared feasible and safe, with excellent procedural success and low in-hospital complication rates. This new technique allows patients with contraindications to the femoral approach to be treated with TAVI.

Original languageEnglish
Pages (from-to)359-366
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume3
Issue number4
DOIs
Publication statusPublished - Aug 2010

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Thigh
Safety
Mortality
Bioprosthesis
Learning Curve
Bundle-Branch Block
Aortic Valve Stenosis
Local Anesthesia
Femoral Artery
Comorbidity
Rupture
Anatomy
Breast
Ischemia
Transcatheter Aortic Valve Replacement

Keywords

  • Aortic stenosis
  • Aortic valve
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system. / Petronio, Anna Sonia; De Carlo, Marco; Bedogni, Francesco; Marzocchi, Antonio; Klugmann, Silvio; Maisano, Francesco; Ramondo, Angelo; Ussia, Gian Paolo; Ettori, Federica; Poli, Arnaldo; Brambilla, Nedy; Saia, Francesco; De Marco, Federico; Colombo, Antonio.

In: Circulation: Cardiovascular Interventions, Vol. 3, No. 4, 08.2010, p. 359-366.

Research output: Contribution to journalArticle

Petronio, Anna Sonia ; De Carlo, Marco ; Bedogni, Francesco ; Marzocchi, Antonio ; Klugmann, Silvio ; Maisano, Francesco ; Ramondo, Angelo ; Ussia, Gian Paolo ; Ettori, Federica ; Poli, Arnaldo ; Brambilla, Nedy ; Saia, Francesco ; De Marco, Federico ; Colombo, Antonio. / Safety and efficacy of the subclavian approach for transcatheter aortic valve implantation with the CoreValve revalving system. In: Circulation: Cardiovascular Interventions. 2010 ; Vol. 3, No. 4. pp. 359-366.
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abstract = "Background-Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. The standard retrograde approach through the femoral artery is contraindicated in case of unfavorable iliofemoral anatomy or extensive disease. In these patients, a trans-subclavian approach may be feasible. Methods and Results-Between June 2007 and July 2009, TAVI with the CoreValve bioprosthesis (Medtronic, Minneapolis, Minn) was performed in 514 consecutive patients at 13 Italian hospitals, using the subclavian approach in 54 cases. The median logistic EuroSCORE was significantly higher in the subclavian (19.4; interquartile range, 12.5 to 29.8) versus femoral group (25.3; interquartile range, 15.1 to 36.6) (P=0.03), as well as the rate of comorbidities. Procedural success was obtained in 100{\%} versus 98.4{\%} of the subclavian versus femoral groups, respectively (P=0.62), with intraprocedural mortality of 0{\%} versus 0.9{\%} (P=1.00). The most common in-hospital complications were a new left bundle-branch block (22.4{\%}) and the need for pacemaker (16.3{\%}). No specific complications for the subclavian access (vessel rupture, vertebral or internal mammary ischemia) were reported. The learning curve for the subclavian approach led to a wider use of local anesthesia. Thirty-day mortality was 0{\%} versus 6.1{\%} in the subclavian versus femoral groups, respectively (P=0.13). Six-month mortality rate was 9.4{\%} versus 15.8{\%} (P=0.44), whereas valve-related adverse events were 13.6{\%} versus 13.9{\%} (P=0.79). Conclusions-TAVI through the subclavian approach appeared feasible and safe, with excellent procedural success and low in-hospital complication rates. This new technique allows patients with contraindications to the femoral approach to be treated with TAVI.",
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AU - Petronio, Anna Sonia

AU - De Carlo, Marco

AU - Bedogni, Francesco

AU - Marzocchi, Antonio

AU - Klugmann, Silvio

AU - Maisano, Francesco

AU - Ramondo, Angelo

AU - Ussia, Gian Paolo

AU - Ettori, Federica

AU - Poli, Arnaldo

AU - Brambilla, Nedy

AU - Saia, Francesco

AU - De Marco, Federico

AU - Colombo, Antonio

PY - 2010/8

Y1 - 2010/8

N2 - Background-Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. The standard retrograde approach through the femoral artery is contraindicated in case of unfavorable iliofemoral anatomy or extensive disease. In these patients, a trans-subclavian approach may be feasible. Methods and Results-Between June 2007 and July 2009, TAVI with the CoreValve bioprosthesis (Medtronic, Minneapolis, Minn) was performed in 514 consecutive patients at 13 Italian hospitals, using the subclavian approach in 54 cases. The median logistic EuroSCORE was significantly higher in the subclavian (19.4; interquartile range, 12.5 to 29.8) versus femoral group (25.3; interquartile range, 15.1 to 36.6) (P=0.03), as well as the rate of comorbidities. Procedural success was obtained in 100% versus 98.4% of the subclavian versus femoral groups, respectively (P=0.62), with intraprocedural mortality of 0% versus 0.9% (P=1.00). The most common in-hospital complications were a new left bundle-branch block (22.4%) and the need for pacemaker (16.3%). No specific complications for the subclavian access (vessel rupture, vertebral or internal mammary ischemia) were reported. The learning curve for the subclavian approach led to a wider use of local anesthesia. Thirty-day mortality was 0% versus 6.1% in the subclavian versus femoral groups, respectively (P=0.13). Six-month mortality rate was 9.4% versus 15.8% (P=0.44), whereas valve-related adverse events were 13.6% versus 13.9% (P=0.79). Conclusions-TAVI through the subclavian approach appeared feasible and safe, with excellent procedural success and low in-hospital complication rates. This new technique allows patients with contraindications to the femoral approach to be treated with TAVI.

AB - Background-Transcatheter aortic valve implantation (TAVI) is a new option for patients with severe aortic stenosis at high surgical risk. The standard retrograde approach through the femoral artery is contraindicated in case of unfavorable iliofemoral anatomy or extensive disease. In these patients, a trans-subclavian approach may be feasible. Methods and Results-Between June 2007 and July 2009, TAVI with the CoreValve bioprosthesis (Medtronic, Minneapolis, Minn) was performed in 514 consecutive patients at 13 Italian hospitals, using the subclavian approach in 54 cases. The median logistic EuroSCORE was significantly higher in the subclavian (19.4; interquartile range, 12.5 to 29.8) versus femoral group (25.3; interquartile range, 15.1 to 36.6) (P=0.03), as well as the rate of comorbidities. Procedural success was obtained in 100% versus 98.4% of the subclavian versus femoral groups, respectively (P=0.62), with intraprocedural mortality of 0% versus 0.9% (P=1.00). The most common in-hospital complications were a new left bundle-branch block (22.4%) and the need for pacemaker (16.3%). No specific complications for the subclavian access (vessel rupture, vertebral or internal mammary ischemia) were reported. The learning curve for the subclavian approach led to a wider use of local anesthesia. Thirty-day mortality was 0% versus 6.1% in the subclavian versus femoral groups, respectively (P=0.13). Six-month mortality rate was 9.4% versus 15.8% (P=0.44), whereas valve-related adverse events were 13.6% versus 13.9% (P=0.79). Conclusions-TAVI through the subclavian approach appeared feasible and safe, with excellent procedural success and low in-hospital complication rates. This new technique allows patients with contraindications to the femoral approach to be treated with TAVI.

KW - Aortic stenosis

KW - Aortic valve

KW - Transcatheter aortic valve implantation

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