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The left axillary artery — a new approach for transcatheter aortic valve implantation

Departments of Cardiac Surgery, Cardiology and Anaesthetics, Royal Brompton & Harefield NHS Trust, London, UK

Received 3 September 2008; received in revised form 22 April 2009; accepted 27 April 2009.

^_* Corresponding author. Address: Department of Cardiac Surgery, Royal Brompton & Harefield NHS Trust, Sydney Street, SW3 6NP, London, UK. Tel.: +44 2073518564; fax: +44 2073518564. (Email: N.Moat{at}rbht.nhs.uk).

Objective: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for aortic stenosis in selected cases, but requires appropriate vascular access. We report our initial clinical experience with a novel endovascular approach for TAVI. Methods: Between 1 April 2007 and 31 August 2008, 48 patients underwent TAVI at our institution. Of these, eight patients (17%) were deemed to be best served through direct surgical exposure of the left axillary artery rather than a trans-femoral or TA approach. Results: Procedural success was achieved in seven of eight cases. In one patient the axillary artery was too small to accept the 18 French sheath. In the remaining seven, the device was implanted without major complication and with only trivial paravalvular aortic regurgitation. The in-hospital mortality was 0%. The 30-day mortality was 12.5% (one patient). There was one localised dissection at the origin of the vertebral artery. There was one late pericardial effusion and a permanent pacemaker was implanted in five patients. Conclusions: TAVI can be performed through a left axillary artery approach. This is a technically simple procedure and, in this small initial clinical experience, was performed with encouraging results. It is a realistic option in patients in whom neither the trans-femoral or trans-apical approaches are optimal.

Key Words: Valvular disease • Aortic stenosis • Percutaneous valve interventions