Interventions for valvular disease and heart failure

Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry

EuroIntervention 2020;15:e1319-e1324. DOI: 10.4244/EIJ-D-19-00797

Giulia Costa
Giulia Costa1, MD; Ole De Backer1, MD, PhD; Thomas Pilgrim2, MD; Markus Kasel3, MD; Simon Redwood4, MD; Adel Aminian5, MD; Jonas Lanz2, MD; Jonathan Michel3, MD; Tiffany Patterson4, MD; Stephan Windecker2, MD; Bernard Prendergast4, MD, FRCP; Adam B. Greenbaum6, MD; Lars Søndergaard1, MD, DMSc
1. Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2. Inselspital, Bern Universitatsspital, Bern, Switzerland; 3. Deutsches Herzzentrum Munchen, Munich, Germany; 4. St Thomas Hospital, London, United Kingdom; 5. Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium; 6. Emory University Hospital, Atlanta, GA, USA

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 out 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 proved 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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aortic stenosisothertavi
Interventions for valvular diseaseTAVI
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