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Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral.

Publication ,  Journal Article
Gleason, TG; Schindler, JT; Hagberg, RC; Deeb, GM; Adams, DH; Conte, JV; Zorn, GL; Hughes, GC; Guo, J; Popma, JJ; Reardon, MJ
Published in: Ann Thorac Surg
February 2018

BACKGROUND: Iliofemoral arterial disease can preclude transfemoral (TF) transcatheter aortic valve replacement (TF-TAVR). Transthoracic access by direct aortic or a transapical approach imparts a greater risk of complications and death than TF access. We hypothesized that subclavian/axillary arterial (SCA) access offers equivalent risks and outcomes as TF access. METHODS: The outcomes of 202 patients from the CoreValve (Medtronic, Minneapolis, MN) United States Pivotal Trial Program treated with SCA access were propensity matched with patients treated with TF access and analyzed. RESULTS: Matching was successful, with no significant baseline differences in the SCA group and the TF group, except the SCA group had more past or present smokers (79.2% vs 61.4%, p < 0.001) and fewer patients with anemia requiring transfusion (18.5% vs 27.5%, p = 0.04). SCA patients experienced a significantly longer time from enrollment to procedure (8.6 ± 19.1 vs 5.3 ± 6.3 days; p = 0.02), likely the result of case planning. Significant differences in procedural outcomes include less post-TAVR balloon dilation (17.9% vs 26.7%, p = 0.03) and more general anesthesia (99.0% vs 89.6%, p < 0.001) for the SCA accesses. There were no differences in procedure time (57.8 ± 45.3 vs 57.5 ± 32.1 min, p = 0.94) or Valve Academic Research Consortium I-defined procedure success between groups (p = 0.89). Event rates at 30 days or 1 year were similar, with a trend toward fewer pacemakers with SCA accesses. CONCLUSIONS: Major morbidity and mortality rates SCA-TAVR are equivalent to TF-TAVR. The SCA should be the preferred secondary access site for TAVR because it offers procedural and clinical outcomes comparable to TF-TAVR and applies to most patients who are not TF candidates.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2018

Volume

105

Issue

2

Start / End Page

477 / 483

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Subclavian Artery
  • Severity of Illness Index
  • Risk Assessment
  • Respiratory System
  • Prosthesis Design
 

Citation

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Gleason, T. G., Schindler, J. T., Hagberg, R. C., Deeb, G. M., Adams, D. H., Conte, J. V., … Reardon, M. J. (2018). Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg, 105(2), 477–483. https://doi.org/10.1016/j.athoracsur.2017.07.017
Gleason, Thomas G., John T. Schindler, Robert C. Hagberg, G Michael Deeb, David H. Adams, John V. Conte, George L. Zorn, et al. “Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral.Ann Thorac Surg 105, no. 2 (February 2018): 477–83. https://doi.org/10.1016/j.athoracsur.2017.07.017.
Gleason TG, Schindler JT, Hagberg RC, Deeb GM, Adams DH, Conte JV, et al. Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg. 2018 Feb;105(2):477–83.
Gleason, Thomas G., et al. “Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral.Ann Thorac Surg, vol. 105, no. 2, Feb. 2018, pp. 477–83. Pubmed, doi:10.1016/j.athoracsur.2017.07.017.
Gleason TG, Schindler JT, Hagberg RC, Deeb GM, Adams DH, Conte JV, Zorn GL, Hughes GC, Guo J, Popma JJ, Reardon MJ. Subclavian/Axillary Access for Self-Expanding Transcatheter Aortic Valve Replacement Renders Equivalent Outcomes as Transfemoral. Ann Thorac Surg. 2018 Feb;105(2):477–483.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

February 2018

Volume

105

Issue

2

Start / End Page

477 / 483

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Survival Rate
  • Subclavian Artery
  • Severity of Illness Index
  • Risk Assessment
  • Respiratory System
  • Prosthesis Design