title: Transcutaneous aortic valve implantation using the axillary/subclavian access with patent left internal thoracic artery to left anterior descending artery: feasibility and early clinical outcomes.
abstract: OBJECTIVE
  Both retrograde femoral and subclavian artery catheterization techniques have been described as the most common methods for the implantation of the Medtronic CoreValve percutaneous aortic valve (Medtronic Inc, Minneapolis, Minn). The subclavian artery has been shown to be a safe and effective alternative access route in patients with unfavorable femoral access. Of the patients who are identified as candidates for subclavian artery access, a subset possess a patent left internal thoracic artery to left anterior descending artery. This patent left internal thoracic artery presents an additional anatomic and clinical variable that must be taken into consideration to ensure procedural safety and efficacy. We describe the Medtronic CoreValve percutaneous aortic valve implantation using the subclavian arterial approach in patients with a patent left internal thoracic artery and report our study's findings.
  
  
  METHODS
  The CoreValve percutaneous aortic valve is a self-expandable nitinol-based frame with a porcine pericardial valve. The subclavian access was created by a small infraclavicular surgical incision to expose the artery. Rapid ventricular pacing was used to reduce cardiac output to perform the balloon aortic valvuloplasty via a 12F sheath inserted into the subclavian artery. An 18F sheath was then inserted into the artery down into the ascending aorta and used for introduction of the delivery catheter and implantation of the percutaneous aortic valve.
  
  
  RESULTS
  With the use of this method, 19 patients (76 ± 13 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications have received implants. Subclavian artery or left internal thoracic artery injury did not occur in any patient. Two deaths occurred. One patient died of right coronary artery occlusion during the procedure, and one patient died 48 hours after the procedure as the result of a tamponade after the temporary pacemaker wire ablation.
  
  
  CONCLUSIONS
  This initial experience suggests that subclavian transarterial aortic valve implantation in patients with a patent left internal thoracic artery to left anterior descending artery is feasible and safe with satisfactory short-term outcomes.
authors.affiliation: CHRU de Lille, Marseille, France. t1modine@yahoo.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.forename: Arnaud
authors.initials: A
authors.lastname: Sudre
authors.forename: Frederic
authors.initials: F
authors.lastname: Collet
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: G
authors.initials: G
authors.lastname: Lemesles
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.forename: M
authors.initials: M
authors.lastname: Koussa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000628:therapy*; D001366:Axillary Artery; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013348:Subclavian Artery; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000497:Alloys; C013616:nitinol