• Ann. Thorac. Surg. · Feb 2018

    Randomized Controlled Trial Multicenter Study

    Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral.

    • Thomas G Gleason, John T Schindler, Robert C Hagberg, G Michael Deeb, David H Adams, John V Conte, George L Zorn, G Chad Hughes, Jia Guo, Jeffrey J Popma, and Michael J Reardon.
    • Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: gleasontg@upmc.edu.
    • Ann. Thorac. Surg. 2018 Feb 1; 105 (2): 477-483.

    BackgroundIliofemoral arterial disease can preclude transfemoral (TF) transcatheter aortic valve replacement (TF-TAVR). Transthoracic access by direct aortic or a transapical approach imparts a greater risk of complications and death than TF access. We hypothesized that subclavian/axillary arterial (SCA) access offers equivalent risks and outcomes as TF access.MethodsThe outcomes of 202 patients from the CoreValve (Medtronic, Minneapolis, MN) United States Pivotal Trial Program treated with SCA access were propensity matched with patients treated with TF access and analyzed.ResultsMatching was successful, with no significant baseline differences in the SCA group and the TF group, except the SCA group had more past or present smokers (79.2% vs 61.4%, p < 0.001) and fewer patients with anemia requiring transfusion (18.5% vs 27.5%, p = 0.04). SCA patients experienced a significantly longer time from enrollment to procedure (8.6 ± 19.1 vs 5.3 ± 6.3 days; p = 0.02), likely the result of case planning. Significant differences in procedural outcomes include less post-TAVR balloon dilation (17.9% vs 26.7%, p = 0.03) and more general anesthesia (99.0% vs 89.6%, p < 0.001) for the SCA accesses. There were no differences in procedure time (57.8 ± 45.3 vs 57.5 ± 32.1 min, p = 0.94) or Valve Academic Research Consortium I-defined procedure success between groups (p = 0.89). Event rates at 30 days or 1 year were similar, with a trend toward fewer pacemakers with SCA accesses.ConclusionsMajor morbidity and mortality rates SCA-TAVR are equivalent to TF-TAVR. The SCA should be the preferred secondary access site for TAVR because it offers procedural and clinical outcomes comparable to TF-TAVR and applies to most patients who are not TF candidates.Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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