Initial European experience with transcaval transcatheter aortic valve implantation.

Costa, Giulia; De Backer, Ole; Pilgrim, Thomas; Kasel, Markus; Redwood, Simon; Aminian, Adel; Lanz, Jonas; Michel, Jonathan; Patterson, Tiffany; Windecker, Stephan; Prendergast, Bernard; Greenbaum, Adam B; Søndergaard, Lars (2020). Initial European experience with transcaval transcatheter aortic valve implantation. EuroIntervention, 15(15), e1319-e1324. Europa Digital & Publishing 10.4244/EIJ-D-19-00797

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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 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 proofs to be a feasible and safe TAVI approach for high-risk patients with severe aortic stenosis not suitable for transfemoral or transaxillary/subclavian transarterial access.

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