Feasibility and Outcomes of Transcatheter Aortic Valve Implantation Using the Left Axillary Artery as Primary Access Site.

Autor:	van der Wulp K; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Verkroost MWA; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., van Wely MH; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Gehlmann HR; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Van Garsse LAFM; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Noyez L; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Brouwer MA; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Kievit PC; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., De Boer MJ; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Suryapranata H; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Morshuis WJ; Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., van Royen N; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: niels.vanroyen@radboudumc.nl.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2019 Feb; Vol. 107 (2), pp. 546-552. Date of Electronic Publication: 2018 Oct 04.
DOI:	10.1016/j.athoracsur.2018.07.093
Abstrakt:	Background: The femoral artery is generally used as primary access for transcatheter aortic valve implantation. However, peripheral artery disease often precludes femoral access. The purpose of this study was to describe clinical outcome of transcatheter aortic valve implantation using the left axillary artery (LAA) as primary access site. Methods: From December 2008 until June 2016, data on all consecutive patients treated with a Medtronic device through the LAA at our hospital were registered, and outcome was prospectively collected according to the updated Valve Academic Research Consortium-2 criteria. Mortality check was performed nationally. Results: In total, 362 patients were included (median age 80 years [range, 76 to 84]; logistic European System for Cardiac Operative Risk Evaluation 17% ± 12%). Successful axillary access was achieved in 99%. Medtronic CoreValve (86%) and Evolut R (14% [Medtronic, Minneapolis, MN]) were implanted. Major vascular complications occurred in 5% of patients, 1% was LAA related. Life-threatening bleeding and major bleeding were observed in 2% and 10%, respectively. Additional complications were new left bundle branch blood (30%), new permanent pacemaker (11%), and stroke (1%). There were 6 procedural deaths (2%) and 19 deaths (5%) within 30 days. One-year mortality rate was 19%. Conclusions: This is the first study reporting outcome after transcatheter aortic valve implantation using the LAA as default access. We conclude that it is highly feasible and safe with low rates of major vascular complications, bleeding, and stroke. (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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