Transcatheter aortic valve implantation by left subclavian access in the presence of a patent LIMA to LAD graft.

We present a case of successful implantation of the Corevalve aortic bioprosthesis via the left subclavian artery in a patient with a patent internal mammary graft to the left anterior descending artery. This unusual choice of access, in the presence of adequate caliber femoral arteries, was justified by the presence of mobile thrombi in the abdominal aorta. The risk of thrombus dislodgement and subsequent major cholesterol embolization was deemed higher than the risk of coronary ischemia due to the large caliber sheath required for transcatheter aortic valve implantation. This case shows that presence of a LIMA to LAD graft is not an absolute contraindication for homolateral subclavian access and that the procedure is feasible and relatively safe provided that certain rules are followed.