Document Detail


Transcutaneous aortic valve implantation using the axillary/subclavian access: Feasibility and early clinical outcomes.
MedLine Citation:
PMID:  20434180     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: Retrograde transfemoral artery catheterization is the most common way of implanting a percutaneous aortic valve. But in some cases, this access cannot be used and the subclavian artery access may represent an alternative to the femoral route, even offering certain advantages. This article describes prosthetic aortic valve implantation using the subclavian arterial approach and reports the findings.
METHODS: The valve prosthesis is a self-expandable, nitinol-based device (CoreValve; Medtronic Inc. Minneapolis, Minn). The axillary or subclavian artery was exposed with a small incision. Rapid ventricular pacing was used to reduce cardiac output while a routine aortic balloon valvuloplasty was performed. Then, an 18F sheath was inserted into the axillary artery down into the ascending aorta. By using this method, a prosthesis was implanted in 17 patients (aged 71 ± 11 years) whose surgical risk was deemed excessive because of severe comorbidity and in whom transfemoral catheterization was considered unfeasible or at risk of severe complications.
RESULTS: Subclavian arterial injury did not occur in any patient. The postprocedural aortic valve area increased from 0.6 ± 0.3 cm(2) to 1.44 ± 0.35 cm(2). A transient ischemic attack occurred in 1 patient. Two patients experienced transitory brachial plexus deficit. There were no intraprocedural deaths. Two deaths occurred in the 30-day follow-up period.
CONCLUSIONS: This initial experience suggests that subclavian transarterial aortic valve implantation, in selected high-risk patients, is feasible and safe with satisfactory short-term outcomes.
Authors:
Thomas Modine; Jean François Obadia; Emmanuel Choukroun; Gilles Rioufoul; Arnaud Sudre; Jean Claude Laborde; Pascal Leprince
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  487-491.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
CHRU de Lille, Paris, France.
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