The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Initial European experience with transcaval transcatheter aortic valve implantation

DOI: 10.4244/EIJ-D-19-00797

1. Azienda Ospedaliero Universitaria Pisana, Cardiothoracic and Vascular Department, Pisa, Italy
2. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, Denmark
3. Inselspital, Bern Universitatsspital, Bern, Switzerland
4. Deutsches Herzzentrum Munchen, Munich, Germany
5. St Thomas Hospital, London, UK
6. Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
7. Inselspital, Bern Universitatsspital, Bern, Switzerland
8. Deutsches Herzzentrum Munchen, Munich, Germany
9. St Thomas Hospital, London, UK
10. Inselspital, Bern Universitatsspital, Bern, Switzerland
11. St Thomas Hospital, London, UK
12. Emory University Hospital, Atlanta, USA
13. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Aims:. A transfemoral transarterial approach is considered the preferable access route for transcatheter aortic valve implantation (TAVI), followed by a transaxillary/subclavian TAVI approach. However, these approaches may not be an option in all patients. This study aimed to report the initial European experience with transfemoral transcaval TAVI. 

Methods and results:. Data on 50 patients treated by transcaval TAVI in five European centres were collected and analysed according to the Valve Academic Research Consortium (VARC)-2 definitions. The study population had a mean age of 78.7 ± 8.0 years and a high surgical risk profile (median STS risk score 6.1%, interquartile range 3.0%-11.2%). Transcaval access was successful in 49 of 50 patients and device success was obtained in 94% of cases. Closure of the caval-aortic puncture site with a nitinol cardiac occluder was successful in all cases without need for emergent surgery. One patient received additional sealing of the aortic puncture site with a covered stent one day post-TAVI due to a gradual haemoglobin drop of 3 g/dL. VARC-2-defined life-threatening bleeding and major vascular complications possibly related to transcaval access were 4% and 10%, respectively. There were no bleeding or vascular complications after discharge. At 30 days, the clinical efficacy endpoint was reached in 88% of patients. 

Conclusions:. Transfemoral transcaval access proofs to be a feasible and safe TAVI approach for high-risk patients with severe aortic stenosis not suitable for transfemoral or transaxillary/subclavian transarterial access.

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