Axillary Approach for Transcatheter Aortic Valve Implantation: Optimization of the Endovascular Treatment for the Aortic Valve Stenosis

Introduction and objectives: To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals. Methods: We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach. Results: We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation [SD] +/- 8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD +/- 16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD +/- 21.5) to 15.8 mmHg (SD +/- 5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD +/- 3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%). Conclusions: The axillary approach for transcatheter aortic valve implantation using the CoreValve (R) and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality. (C) 2010 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S. L. All rights reserved.