title: Right subclavian approach as a feasible alternative for transcatheter aortic valve implantation with the CoreValve ReValving System.
abstract: OBJECTIVE
  Arterial access selection is crucial during transcatheter aortic valve implantation. When traditional femoral access has been deemed unfeasible the left subclavian artery has been used successfully. In cases where even the latter was ineligible, we opted, despite the lack of any data, for the right subclavian approach. We hereby present the results of the first series available. Our aim was to evaluate the feasibility and performance of the CoreValve ReValving System (CRS) implantation via the right subclavian artery in patients with contraindication to femoral and left subclavian accesses.
  
  
  RESULTS
  Among 300 patients who have undergone CRS implantation, 70 (23%) have been treated via the subclavian approach, 10 via the right subclavian artery and 60 via the left. Demographic features were quite similar except for the presence of significant left subclavian disease in all patients treated via the right subclavian artery. The success rate was 100% for both groups. At 30-day follow-up, there was no significant difference in terms of all-cause mortality and cardiac mortality between right vs. left subclavian approach (0% vs. 6.6% and 0% vs. 6.6%, respectively). Consistent results were observed at a mean follow-up of 12±7.9 months (all-cause mortality: 10% vs. 15%). Incidences of new AV block requiring PM implantation were also statistically equivalent.
  
  
  CONCLUSIONS
  CRS implantation via the right subclavian artery was as feasible and safe as the left subclavian approach. It poses very particular technical issues but should be considered when more conventional approaches are inadequate in order to provide patients with a further chance to be treated effectively.
authors.affiliation: Istituto Clinico S. Ambrogio, Dept of Interventional Cardiology, Milan, Italy. luctes@gmail.com
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Nedy
authors.initials: N
authors.lastname: Brambilla
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Laudisa
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Stefania
authors.initials: S
authors.lastname: Lanotte
authors.forename: Roberto Adriano
authors.initials: RA
authors.lastname: Latini
authors.forename: Samuele
authors.initials: S
authors.lastname: Pizzocri
authors.forename: Matteo
authors.initials: M
authors.lastname: Casavecchia
authors.forename: Mauro Luca
authors.initials: ML
authors.lastname: Agnifili
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Uberto
authors.initials: U
authors.lastname: Bortolotti
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000000981:diagnostic imaging; D013997:Time Factors; D016896:Treatment Outcome