title: Suprasternal brachiocephalic approach as an alternative route for transcatheter aortic valve implantation: a single-centre experience.
abstract: OBJECTIVE
  The aim of this study was to evaluate the feasibility, safety and outcomes of TAVI performed via the suprasternal brachiocephalic approach in selected patients at high or prohibitive surgical risk who are not eligible for transfemoral or subclavian TAVI.
  
  
  RESULTS
  From March 2014 to March 2016, 26 high-risk patients without transfemoral or subclavian access options were considered for TAVI via a suprasternal brachiocephalic approach. The feasibility of the suprasternal brachiocephalic approach was determined according to computed tomography findings. In 23 (88.4%) patients the procedure was performed as intended, whereas in three (11.5%) patients the approach was converted to a right carotid access. Both self-expanding (n=20, 76.9%) and balloon-expandable prostheses (n=6, 23.1%) were used. At 30 days, no patient had died; there was one major stroke (3.8%) and there were three major vascular access site-related complications (11.5%). After a median follow-up of 317 days (57-705), two patients had died, both from cardiovascular causes, and 19 out of 24 survivors (79.2%) were in New York Heart Association functional Class I or II.
  
  
  CONCLUSIONS
  This single-centre case series suggests that TAVI using the suprasternal brachiocephalic approach is feasible in selected patients and may represent an additional alternative route in patients who are not eligible for other approaches.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Capretti
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Walid
authors.initials: W
authors.lastname: Ghodbane
authors.forename: Constance
authors.initials: C
authors.lastname: Gardy Verdonk
authors.forename: Coppelia
authors.initials: C
authors.lastname: Goublaire
authors.forename: Soleiman
authors.initials: S
authors.lastname: Alkhoder
authors.forename: Richard
authors.initials: R
authors.lastname: Raffoul
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Carrasco
authors.forename: Mikael
authors.initials: M
authors.lastname: Laredo
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome