title: Transaxillary versus transaortic approach for transcatheter aortic valve implantation with CoreValve Revalving System: insights from multicenter experience.
abstract: BACKGROUND
  About one-third of candidates for transcatheter aortic valve implantation (TAVI) suffer from severe peripheral artery disease, making the routine femoral approach difficult or impossible. The aim was to compare the transaxillary (TAx) and the transaortic (TAo) route for TAVI with Medtronic CoreValve Revalving System (CRS).
  
  
  METHODS
  Out of 1049 consecutive TAVI with 18F CRS, 242 (23%) were treated in 4 high-volume Italian Centre through TAx (61%) and TAo (39%).
  
  
  RESULTS
  The devices success was similar (P=0.16) with a trend to a lower incidence of significant paravalvular leak (6% vs. 14%, P=0.07) and a significant reduction of permanent pacemaker (PPM) implantation (13% vs. 34%, P=0.017) in the TAo. However, this route showed a higher incidence of acute kidney injury (P=0.016) and a longer hospital stay after the index procedure (days 10 [8-14] vs. 8 [7-12], P=0.001). By a multivariate analysis the vascular access is an independent predictor for a longer hospital stay (TAo route; OR=0.37, 95% CI: 0.18-0.75; P=0.006) and for PPM implantation (TAx route; OR=3.7, 95% CI: 1.2-10.8; P=0.017).
  
  
  CONCLUSIONS
  Although the higher clinical risk profile of transaortic population, the TAo approach showed an equally high device success with similar 30-day safety and 1year efficacy, compared to TAx route. However, due to non-procedure-specific complications post-TAo TAVI, this route requires a specialized postoperative care and the treatment of patients in highly specialized and experienced centers.
authors.affiliation: Spedali Civili Brescia, Brescia, Italy - clafiorina@yahoo.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.affiliation: Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.affiliation: IRCCS Policlinico S. Donato, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.affiliation: Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: DE Carlo
authors.affiliation: IRCCS Policlinico S. Donato, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: DE Marco
authors.affiliation: Spedali Civili Brescia, Brescia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Coletti
authors.affiliation: Spedali Civili Brescia, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonardelli
authors.affiliation: Spedali Civili Brescia, Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Adamo
authors.affiliation: Spedali Civili Brescia, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Curello
authors.affiliation: Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scioti
authors.affiliation: IRCCS Policlinico S. Donato, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Panisi
authors.affiliation: IRCCS Policlinico S. Donato, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.affiliation: Spedali Civili Brescia, Brescia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000000981:diagnostic imaging; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D001366:Axillary Artery / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061847:Hospitals, High-Volume; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications; D011677:Punctures; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome