Feasibility and safety of transcaval transcatheter aortic valve implantation: A multicentre European registry

Giulia Costa, Ole De Backer*, Thomas Pilgrim, Markus Kasel, Simon Redwood, Adel Aminian, Jonas Lanz, Jonathan Michel, Tiffany Patterson, Stephan Windecker, Bernard Prendergast, Adam B. Greenbaum, Lars Søndergaard

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

18 Citations (Scopus)

Abstract

Aims: A transfemoral transarterial approach is considered the preferable access route for transcatheter aortic valve implantation (TAVI), followed by a transaxillary/subclavian TAVI approach. However, these approaches may not be an option in all patients. This study aimed to report the initial European experience with transfemoral transcaval TAVI. Methods and results: Data on 50 patients treated by transcaval TAVI in five European centres were collected and analysed according to the Valve Academic Research Consortium (VARC)-2 definitions. The study population had a mean age of 78.7±8.0 years and a high surgical risk profile (median STS risk score 6.1%, interquartile range 3.0-11.2%). Transcaval access was successful in 49 out of 50 patients and device success was obtained in 94% of cases. Closure of the caval-aortic puncture site with a nitinol cardiac occluder was successful in all cases without need for emergent surgery. One patient received additional sealing of the aortic puncture site with a covered stent one day post TAVI due to a gradual haemoglobin drop of 3 g/dL. VARC-2-defined life-threatening bleeding and major vascular complications possibly related to transcaval access were 4% and 10%, respectively. There were no bleeding or vascular complications after discharge. At 30 days, the clinical efficacy endpoint was reached in 88% of patients. Conclusions: Transfemoral transcaval access proved to be a feasible and safe TAVI approach for highrisk patients with severe aortic stenosis not suitable for transfemoral or transaxillary/subclavian transarterial access.

Original languageEnglish
JournalEuroIntervention
Volume15
Issue number15
Pages (from-to)E1319-E1324
ISSN1774-024X
DOIs
Publication statusPublished - 2020

Keywords

  • Aortic stenosis
  • Other
  • TAVI

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