The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article
Background: Transfemoral transcatheter aortic valve implantation (TAVI) has proven non-inferior or superior against surgical aortic valve replacement (SAVR) for patients at high, intermediate or low surgical risk. However, transfemoral access is not always feasible in patients with severely atherosc...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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IMR Press
2023-05-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/24/5/10.31083/j.rcm2405150 |
| _version_ | 1827936295117127680 |
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| author | Andries Herremans Dylan Thomas Stevesyns Hicham El Jattari Michaël Rosseel Liesbeth Rosseel |
| author_facet | Andries Herremans Dylan Thomas Stevesyns Hicham El Jattari Michaël Rosseel Liesbeth Rosseel |
| author_sort | Andries Herremans |
| collection | DOAJ |
| description | Background: Transfemoral transcatheter aortic valve implantation (TAVI) has proven non-inferior or superior against surgical aortic valve replacement (SAVR) for patients at high, intermediate or low surgical risk. However, transfemoral access is not always feasible in patients with severely atherosclerotic or tortuous iliofemoral arteries. For these cases, alternative access techniques have been developed, such as transcarotid, transcaval, direct aortic or transaxillary access. In recent years, growing preference towards the transaxillary access has emerged. To provide a summary of data available on transaxillary TAVI and compare this approach to other alternative access techniques. Methods: A literature search was performed in PubMed by two independent reviewers. Studies reporting the outcome of at least 10 patients who underwent transaxillary TAVI, either in case series or in comparative studies, were included in this review. Articles not reporting outcomes according to the Valve Academic Research Consortium (VARC) 1–3 definitions were excluded. Results: In total 193 records were found of which 18 were withheld for inclusion in this review. This review reports on the combined data of the 1519 patients who underwent transaxillary TAVI. Procedural success was achieved in 1203 (92.2%) of 1305 cases. Life-threatening, major, and minor bleeding occurred respectively in 4.5% (n = 50 in 1112 cases), 12.9% (n = 143 in 1112 cases) and 8.8% (n = 86 in 978 cases). Major and minor vascular complications were reported in respectively 6.6% (n = 83 in 1256 cases) and 10.0% (n = 105 in 1048 cases) of patients. 30-day mortality was 5.2% (n = 76 out of 1457 cases). At one year follow-up, the mortality rate was 1% (n = 184 out of 1082 cases). Similar 30-day and 1-year mortality is observed in studies that compare with transaxillary, transfemoral or other alternative access techniques (p > 0.05). Conclusions: A wide application of transaxillary access as an alternative approach for TAVI has emerged. This technique has an excellent procedural success rate up to 92.0%, with low procedural complication rates. Clinical outcome of transaxillary TAVI is comparable to the other alternative TAVI approaches. However, these conclusions are solely based on observational data. |
| first_indexed | 2024-03-13T08:08:03Z |
| format | Article |
| id | doaj.art-1bac898de146424c86fad65f605303f9 |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-03-13T08:08:03Z |
| publishDate | 2023-05-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-1bac898de146424c86fad65f605303f92023-06-01T01:35:07ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-05-0124515010.31083/j.rcm2405150S1530-6550(23)00892-XThe Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review ArticleAndries Herremans0Dylan Thomas Stevesyns1Hicham El Jattari2Michaël Rosseel3Liesbeth Rosseel4Department of Cardiology, Algemeen Stedelijk Ziekenhuis, 9300 Aalst, Oost-Vlaanderen, BelgiumDepartment of Cardiology, Algemeen Stedelijk Ziekenhuis, 9300 Aalst, Oost-Vlaanderen, BelgiumDepartment of Cardiology, Algemeen Stedelijk Ziekenhuis, 9300 Aalst, Oost-Vlaanderen, BelgiumDepartment of Cardiology, Algemeen Stedelijk Ziekenhuis, 9300 Aalst, Oost-Vlaanderen, BelgiumDepartment of Cardiology, Algemeen Stedelijk Ziekenhuis, 9300 Aalst, Oost-Vlaanderen, BelgiumBackground: Transfemoral transcatheter aortic valve implantation (TAVI) has proven non-inferior or superior against surgical aortic valve replacement (SAVR) for patients at high, intermediate or low surgical risk. However, transfemoral access is not always feasible in patients with severely atherosclerotic or tortuous iliofemoral arteries. For these cases, alternative access techniques have been developed, such as transcarotid, transcaval, direct aortic or transaxillary access. In recent years, growing preference towards the transaxillary access has emerged. To provide a summary of data available on transaxillary TAVI and compare this approach to other alternative access techniques. Methods: A literature search was performed in PubMed by two independent reviewers. Studies reporting the outcome of at least 10 patients who underwent transaxillary TAVI, either in case series or in comparative studies, were included in this review. Articles not reporting outcomes according to the Valve Academic Research Consortium (VARC) 1–3 definitions were excluded. Results: In total 193 records were found of which 18 were withheld for inclusion in this review. This review reports on the combined data of the 1519 patients who underwent transaxillary TAVI. Procedural success was achieved in 1203 (92.2%) of 1305 cases. Life-threatening, major, and minor bleeding occurred respectively in 4.5% (n = 50 in 1112 cases), 12.9% (n = 143 in 1112 cases) and 8.8% (n = 86 in 978 cases). Major and minor vascular complications were reported in respectively 6.6% (n = 83 in 1256 cases) and 10.0% (n = 105 in 1048 cases) of patients. 30-day mortality was 5.2% (n = 76 out of 1457 cases). At one year follow-up, the mortality rate was 1% (n = 184 out of 1082 cases). Similar 30-day and 1-year mortality is observed in studies that compare with transaxillary, transfemoral or other alternative access techniques (p > 0.05). Conclusions: A wide application of transaxillary access as an alternative approach for TAVI has emerged. This technique has an excellent procedural success rate up to 92.0%, with low procedural complication rates. Clinical outcome of transaxillary TAVI is comparable to the other alternative TAVI approaches. However, these conclusions are solely based on observational data.https://www.imrpress.com/journal/RCM/24/5/10.31083/j.rcm2405150transcatheter aortic valve implantationtavitransaxillaryaortic valve stenosisinterventional cardiology |
| spellingShingle | Andries Herremans Dylan Thomas Stevesyns Hicham El Jattari Michaël Rosseel Liesbeth Rosseel The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article Reviews in Cardiovascular Medicine transcatheter aortic valve implantation tavi transaxillary aortic valve stenosis interventional cardiology |
| title | The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article |
| title_full | The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article |
| title_fullStr | The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article |
| title_full_unstemmed | The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article |
| title_short | The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes—A Systematic Review Article |
| title_sort | place of transaxillary access in transcatheter aortic valve implantation tavi compared to alternative routes a systematic review article |
| topic | transcatheter aortic valve implantation tavi transaxillary aortic valve stenosis interventional cardiology |
| url | https://www.imrpress.com/journal/RCM/24/5/10.31083/j.rcm2405150 |
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