title: Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients.
abstract: OBJECTIVE
  Transcatheter Aortic Valve Implantation (TAVI) can be performed via the transaxillary approach, but data about complications and procedural outcome is limited.
  
  
  BACKGROUND
  TAVI is an established treatment option for patients at high risk for conventional aortic valve replacement. Nowadays, the transfemoral approach is the most commonly used access for TAVI. Nevertheless, the transfemoral access is not suitable in many patients necessitating alternative approaches.
  
  
  METHODS
  We analyzed the outcome of 100 consecutive cases receiving percutaneous transaxillary TAVI at two different hospitals. Data were retrospectively analyzed by means of procedural, hemodynamic and clinical outcome. In addition, 1st versus 2nd generation devices were analyzed.
  
  
  RESULTS
  Mean age was 78.2±2.1years and the logEuroSCORE I was 24.6±13.9%. Transaxillary TAVI was performed in 85% via the left and in 15% via the right axillary artery. Device success was achieved in 95%. In general, there was a clear learning curve with this approach. No patient experienced a major and 11% a minor access site complication. There was one procedural death (annular rupture) and one peri-procedural TIA. 23% of the patients received a new pacemaker. At discharge, effective orifice area was 1.94±0.16cm2and the mean aortic gradient was 6.8±2.1mmHg. Moderate aortic regurgitation/paravalvular leakage was documented in two patients. Mortality rates at 30days and one year were 6% and 14.8%. Last but not least, 2nd generation devices showed improved procedural outcomes.
  
  
  CONCLUSIONS
  The percutaneous transaxillary access for TAVI is technically feasible and safe thereby yielding excellent clinical results.
  
  
  CONCLUSIONS
  We investigated In 100 consecutive patients undergoing percutaneous transaxillary transcatheter aortic valve implantation thereby demonstrating that this approach is technically feasible and safe with acceptable numbers of minor vascular complications.
authors.affiliation: Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany. Electronic address: u.schaefer@uke.de.
authors.forename: U
authors.initials: U
authors.lastname: Schäfer
authors.affiliation: Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Deuschl
authors.affiliation: Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Schofer
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Frerker
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schmidt
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kreidel
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schirmer
authors.affiliation: Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Mizote
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Treede
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Conradi
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D001366:Axillary Artery; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Aortic stenosis; Transaxillary access; Transcatheter aortic valve implantation