2-year results of CoreValve implantation through the subclavian access: a propensity-matched comparison with the femoral access.
OBJECTIVE
The goal of this study was to assess the procedural and 2-year results of the subclavian approach for transcatheter aortic valve implantation (TAVI) compared with those of the femoral approach by using propensity-matched analysis.


BACKGROUND
The subclavian approach with the CoreValve prosthesis (Medtronic, Inc., Minneapolis, Minnesota) represents an interesting opportunity when the femoral access is unfeasible.


METHODS
All consecutive patients enrolled in the Italian CoreValve Registry who underwent TAVI with the subclavian approach were included. Propensity score analysis was used to identify a matching group of patients undergoing femoral TAVI.


RESULTS
Subclavian approach was used in 141 patients (61% men; median age 83 years; median logistic European System for Cardiac Operative Risk Evaluation score 23.7%). The femoral group of 141 patients was matched for baseline clinical characteristics, except for peripheral artery disease. The 2 groups showed similar procedural success (97.9% vs. 96.5%; p = 0.47), major vascular complications (5.0% vs. 7.8%; p = 0.33), life-threatening bleeding events (7.8% vs. 5.7%; p = 0.48), and combined safety endpoint (19.9% vs. 25.5%; p = 0.26). The subclavian group showed lower rates of acute kidney injury/stage 3 (4.3% vs. 9.9%; p = 0.02), of minor vascular complications at the 18-F sheath insertion site (2.1% vs. 11.3%; p = 0.003), and of all types of bleeding events related to vascular complications. Survival at 2 years was 74.0 ± 4.0% in the subclavian group compared with 73.7 ± 3.9% in the femoral group (p = 0.78). The 2-year freedom from cardiovascular death was 87.2 ± 3.1% versus 88.7 ± 2.8% in the subclavian versus femoral group, respectively (p = 0.84).


CONCLUSIONS
The subclavian approach for TAVI is safe and feasible, with procedural and medium-term results similar to the femoral approach. Subclavian access should be considered a valid option not only when the femoral approach is impossible but also when it is difficult, albeit feasible.
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. as.petronio@gmail.com
Anna Sonia
AS
Petronio
Marco
M
De Carlo
Francesco
F
Bedogni
Francesco
F
Maisano
Federica
F
Ettori
Silvio
S
Klugmann
Arnaldo
A
Poli
Antonio
A
Marzocchi
Gennaro
G
Santoro
Massimo
M
Napodano
Gian Paolo
GP
Ussia
Cristina
C
Giannini
Nedy
N
Brambilla
Antonio
A
Colombo
D058186:Acute Kidney Injury / Q000145:classification / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D002037:Bundle-Branch Block / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D010138:Pacemaker, Artificial; D057216:Propensity Score; D012042:Registries; D020521:Stroke / Q000453:epidemiology; D013348:Subclavian Artery; D016019:Survival Analysis