The Safety and Efficacy of a Minimalist Approach for Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR)

Background: The safety and efficacy of percutaneous transaxillary transcatheter aortic valve replacement (TAVR) require evaluation. Transfemoral (TF) approach is the standard vascular access for TAVR, but some patients require alternative access due to iliofemoral artery disease. Transaxillary access has been shown to be as safe as TF access. There are limited reports of percutaneous transaxillary TAVR with a minimalist approach. Methods: Consecutive patients undergoing percutaneous transaxillary TAVR were enrolled. Clinical and procedural characteristics and clinical outcomes were reviewed and compared to TF TAVR performed during the same period. Results: Among 221 patients who underwent TAVR, 25 patients (11%) had TAVR with a percutaneous transaxillary approach based on computed tomography findings. Median age was 80 years; median STS score was 7%. STS score was higher (7% vs 4%, P = 0.008) and peripheral artery disease was more prevalent (64% vs 13%, P = 0.0001) among patients requiring transaxillary access. Twenty-four (96%) patients underwent the procedure with monitored anesthesia care with pectoral-1 nerve block. Hemostasis was achieved with preapplied Proglide (TM) closure devices, with an additional closure device in 5 patients (20%). Median length of stay was 3 days, longer than in the TF group (2 days). There was no death, stroke, or major vascular complication. One minor vascular complication required surgical repair. Fluoroscopy time was longer in the transaxillary group than in the TF group (20 vs 16 min, P = 0.0004). Conclusions: Percutaneous transaxillary TAVR is a safe and effective alternative approach and can be performed with a minimalist approach with outcomes comparable to TF TAVR.