TY - JOUR

T1 - Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve

T2 - results from the multicenter TAXI registry

AU - Schaefer, Andreas

AU - Bhadra, Oliver D.

AU - Conradi, Lenard

AU - Westermann, Dirk

AU - Kellner, Caroline

AU - De Backer, Ole

AU - Bajoras, Vilhelmas

AU - Sondergaard, Lars

AU - Qureshi, Waqas T.

AU - Kakouros, Nikolaos

AU - Aldrugh, Summer

AU - Amat-Santos, Ignacio

AU - Kaneko, Tsuyoshi

AU - Harloff, Morgan

AU - Teles, Rui

AU - Nolasco, Tiago

AU - Neves, Jose Pedro

AU - Abecasis, Miguel

AU - Werner, Nikos

AU - Lauterbach, Michael

AU - Sacha, Jerzy

AU - Krawczyk, Krzysztof

AU - Trani, Carlo

AU - Romagnoli, Enrico

AU - Mangieri, Antonio

AU - Condello, Francesco

AU - Regueiro, Ander

AU - Brugaletta, Salvatore

AU - Biancari, Fausto

AU - Niemelä, Matti

AU - Giannini, Francesco

AU - Toselli, Marco

AU - Ruggiero, Rossella

AU - Buono, Andrea

AU - Maffeo, Diego

AU - Bruno, Francesco

AU - Conrotto, Federico

AU - D’Ascenzo, Fabrizio

AU - Savontaus, Mikko

AU - Pykäri, Jouni

AU - Ielasi, Alfonso

AU - Tespili, Maurizio

AU - Cimmino, Michele

AU - Albanese, Michele

AU - Biondi-Zoccai, Giuseppe

AU - Corcione, Nicola

AU - Morello, Alberto

AU - Giordano, Arturo

N1 - Publisher Copyright: © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

PY - 2024

Y1 - 2024

N2 - Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. Results: From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. Conclusions: Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.

AB - Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). Methods: For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. Results: From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. Conclusions: Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.

KW - TAVI

KW - TAVR

KW - Transaxillary

KW - Transcatheter valve therapy

KW - Valve disease

U2 - 10.1007/s00392-023-02216-1

DO - 10.1007/s00392-023-02216-1

M3 - Journal article

C2 - 37138103

AN - SCOPUS:85158129537

VL - 113

SP - 48

EP - 57

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

ER -