title: Safety and efficacy of the subclavian access route for TAVI in cases of missing transfemoral access.
abstract: OBJECTIVE
  We retrospectively analysed our experience with the subclavian access transcatheter aortic valve implantation (TAVI) with the self-expandable CoreValve prosthesis and compared the results with transfemorally treated patients.
  
  
  BACKGROUND
  For TAVI, a subclavian access is alternatively used when the femoral arteries are diseased or very small.
  
  
  METHODS
  Between June 2007 and February 2011, 341 patients underwent CoreValve implantation in the German Heart Center, Munich through either transfemoral (n = 301) or subclavian (n = 40) approach. The subclavian approach was chosen where transfemoral approach was not possible.
  
  
  RESULTS
  There was no difference in baseline characteristics between the groups. There were no significant differences between groups for parameters potentially related to improved valve positioning (contrast medium, fluoroscopy time, implantation of a second valve, post-implantation balloon dilatation, valve dislocation, pacemaker implantation, aortic regurgitation), while the procedure duration was longer (105 ± 40 vs. 82 ± 33 min, p = 0.001). With the Kaplan-Meier estimate, survival was not different among groups. Strokes, myocardial ischaemia, and access vessel complications occurred in 2.5, 0, and 7.5 % (subclavian group) vs. 4.3, 2.0, 10.6 % (transfemoral group), ns.
  
  
  CONCLUSIONS
  Our results demonstrate the safety of the subclavian access for TAVI and comparability with the transfemoral approach. With longer duration of the procedure and no significant advantages in clinical outcome, the subclavian access will have an indication for selected patients, while transfemoral TAVI should be considered first choice.
authors.affiliation: Department of Cardiovascular Surgery, German Heart Center, Lazarettstrasse 36, 0636 Munich, Germany. muensterer@dhm.mhn.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Muensterer
authors.forename: Domenico
authors.initials: D
authors.lastname: Mazzitelli
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ruge
authors.forename: Anke
authors.initials: A
authors.lastname: Wagner
authors.forename: Ina
authors.initials: I
authors.lastname: Hettich
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.forename: Sabine
authors.initials: S
authors.lastname: Bleiziffer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011474:Prosthesis Design; D012189:Retrospective Studies; D013348:Subclavian Artery; D013997:Time Factors; D016896:Treatment Outcome