Transcatheter Aortic Valve Implantation via Percutaneous Axillary Access—A UK Registry

Abstract

Background

Alternative access for transcatheter aortic valve implantation (TAVI) is required for the small subset of patients in whom transfemoral (TF) access is not feasible. The most commonly used alternative access route in the United Kingdom is the subclavian/axillary artery, and historically, most have been performed via surgical cutdown. Transaxillary TAVI can be undertaken via a percutaneous route. However, there exists limited data on the safety and efficacy of this technique.

Aims

This study aims to describe the UK experience of percutaneous axillary (PAx) TAVI.

Methods

This retrospective, multicenter study included every TAVI center in the United Kingdom which had performed > 10 PAx TAVI cases as of November 1, 2023. Each center provided data on all PAx cases carried out up to December 31, 2023. Procedural and clinical endpoints as well as adverse events were assessed according to Valve Academic Research Consortium (VARC)-3 definitions.

Results

Nine UK TAVI centers contributed data from 210 PAx cases. VARC-3 technical success was achieved in 92.4%. The incidence of major VARC-3 vascular access site complications was 7.1%, major or life-threatening VARC-3 bleeding occurred in 5.3%, a covered stent was used in 25.2%, and vascular surgical intervention was required in 3.3%. The incidence of in-hospital stroke and mortality were 7.1% and 3.3%, respectively. No statistically significant differences were observed between PAx carried out under conscious sedation (non-GA) and GA with respect to clinical outcomes.

Conclusion

PAx TAVI is viable and can be performed under conscious sedation with no detriment in terms of clinical outcomes. However, the elevated risk of stroke is a concern.