title: The left axillary artery--a new approach for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an alternative treatment for aortic stenosis in selected cases, but requires appropriate vascular access. We report our initial clinical experience with a novel endovascular approach for TAVI.
  
  
  METHODS
  Between 1 April 2007 and 31 August 2008, 48 patients underwent TAVI at our institution. Of these, eight patients (17%) were deemed to be best served through direct surgical exposure of the left axillary artery rather than a trans-femoral or TA approach.
  
  
  RESULTS
  Procedural success was achieved in seven of eight cases. In one patient the axillary artery was too small to accept the 18 French sheath. In the remaining seven, the device was implanted without major complication and with only trivial paravalvular aortic regurgitation. The in-hospital mortality was 0%. The 30-day mortality was 12.5% (one patient). There was one localised dissection at the origin of the vertebral artery. There was one late pericardial effusion and a permanent pacemaker was implanted in five patients.
  
  
  CONCLUSIONS
  TAVI can be performed through a left axillary artery approach. This is a technically simple procedure and, in this small initial clinical experience, was performed with encouraging results. It is a realistic option in patients in whom neither the trans-femoral or trans-apical approaches are optimal.
authors.affiliation: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Trust, London, UK.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
authors.forename: Nicola
authors.initials: N
authors.lastname: Delahunty
authors.forename: Andrea
authors.initials: A
authors.lastname: Kelleher
authors.forename: Richard
authors.initials: R
authors.lastname: Trimlett
authors.forename: Mike
authors.initials: M
authors.lastname: Mullen
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001366:Axillary Artery; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010138:Pacemaker, Artificial; D010490:Pericardial Effusion / Q000209:etiology