title: Brachiocephalic artery access in transcatheter aortic valve implantation: a valuable alternative: 3-year institutional experience.
abstract: OBJECTIVE
  With the expanding use of transcatheter aortic valve implantation (TAVI), we have encountered increasing numbers of patients without ideal femoral access. Although many alternatives have been described, vascular access and access-related complications remain a point of concern. We report our series of 20 patients undergoing TAVI via brachiocephalic artery access.
  
  
  METHODS
  Between September 2011 and May 2014, we performed 107 consecutive CoreValve bioprosthesis implantations, of which 20 were by the brachiocephalic approach due to unfavourable iliac or femoral anatomy.
  
  
  RESULTS
  No vascular or access-related complications were seen. Procedural feasibility, device success and early safety, as defined by the Valve Academic Research Consortium-2 criteria, were good, at 100, 95 and 95%, respectively. No stroke, transient ischaemic attack, acute kidney injury, major vascular or major bleeding complications were observed. At a mean follow-up of 497 days, the 1-year survival rate is 75.0%. Echocardiography at discharge confirmed moderate paravalvular regurgitation in 1 patient and mild paravalvular leakage in 3 patients, and no paravalvular leak more than moderate was seen. Echocardiography at discharge, 6 months and 1 year after TAVI confirmed persistent low mean transvalvular gradients (9, 9 and 10 mmHg, respectively).
  
  
  CONCLUSIONS
  TAVI implantation through the brachiocephalic artery is safe and feasible. The distance between the point of access and the aortic valve annulus is short, improving catheter stability and implant site accuracy. We consider it to be a valuable alternative in patients without femoral access.
authors.affiliation: Department of Cardiac Surgery, UZA - Antwerp University Hospital, Edegem, Belgium tine.philipsen@uza.be.
authors.forename: Tine E
authors.initials: TE
authors.lastname: Philipsen
authors.affiliation: Department of Cardiology, UZA - Antwerp University Hospital, Edegem, Belgium Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium.
authors.forename: Valérie M
authors.initials: VM
authors.lastname: Collas
authors.affiliation: Department of Cardiac Surgery, UZA - Antwerp University Hospital, Edegem, Belgium.
authors.forename: Inez E
authors.initials: IE
authors.lastname: Rodrigus
authors.affiliation: Department of Radiology, UZA - Antwerp University Hospital, Edegem, Belgium.
authors.forename: Rodrigo A
authors.initials: RA
authors.lastname: Salgado
authors.affiliation: Department of Cardiac Surgery, UZA - Antwerp University Hospital, Edegem, Belgium.
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Paelinck
authors.affiliation: Department of Cardiology, UZA - Antwerp University Hospital, Edegem, Belgium.
authors.forename: Christiaan M
authors.initials: CM
authors.lastname: Vrints
authors.affiliation: Department of Cardiology, UZA - Antwerp University Hospital, Edegem, Belgium.
authors.forename: Johan M
authors.initials: JM
authors.lastname: Bosmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D016122:Brachiocephalic Trunk / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D065467:Transcatheter Aortic Valve Replacement
keywords: Alternative access; Aortic valve stenosis; Brachiocephalic artery; Innominate artery; Transcatheter aortic valve implantation