Schäfer U, Deuschl F, Schofer N, Frerker C, Schmidt T, Kuck K H, Kreidel F, Schirmer J, Mizote I, Reichenspurner H, Blankenberg S, Treede H, Conradi L
Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
Department for General and Interventional Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Germany.
Int J Cardiol. 2017 Apr 1;232:247-254. doi: 10.1016/j.ijcard.2017.01.010. Epub 2017 Jan 7.
Transcatheter Aortic Valve Implantation (TAVI) can be performed via the transaxillary approach, but data about complications and procedural outcome is limited.
TAVI is an established treatment option for patients at high risk for conventional aortic valve replacement. Nowadays, the transfemoral approach is the most commonly used access for TAVI. Nevertheless, the transfemoral access is not suitable in many patients necessitating alternative approaches.
We analyzed the outcome of 100 consecutive cases receiving percutaneous transaxillary TAVI at two different hospitals. Data were retrospectively analyzed by means of procedural, hemodynamic and clinical outcome. In addition, 1st versus 2nd generation devices were analyzed.
Mean age was 78.2±2.1years and the logEuroSCORE I was 24.6±13.9%. Transaxillary TAVI was performed in 85% via the left and in 15% via the right axillary artery. Device success was achieved in 95%. In general, there was a clear learning curve with this approach. No patient experienced a major and 11% a minor access site complication. There was one procedural death (annular rupture) and one peri-procedural TIA. 23% of the patients received a new pacemaker. At discharge, effective orifice area was 1.94±0.16cm and the mean aortic gradient was 6.8±2.1mmHg. Moderate aortic regurgitation/paravalvular leakage was documented in two patients. Mortality rates at 30days and one year were 6% and 14.8%. Last but not least, 2nd generation devices showed improved procedural outcomes.
The percutaneous transaxillary access for TAVI is technically feasible and safe thereby yielding excellent clinical results.
We investigated In 100 consecutive patients undergoing percutaneous transaxillary transcatheter aortic valve implantation thereby demonstrating that this approach is technically feasible and safe with acceptable numbers of minor vascular complications.
经导管主动脉瓣植入术（TAVI）可通过经腋动脉途径进行，但关于并发症和手术结果的数据有限。
TAVI是高危传统主动脉瓣置换患者的既定治疗选择。如今，经股动脉途径是TAVI最常用的入路。然而，经股动脉入路在许多患者中并不适用，需要替代入路。
我们分析了两家不同医院连续100例接受经皮经腋动脉TAVI患者的结果。通过手术、血流动力学和临床结果对数据进行回顾性分析。此外，还对第一代和第二代装置进行了分析。
平均年龄为78.2±2.1岁，欧洲心脏手术风险评估系统（EuroSCORE）I评分为24.6±13.9%。85%的经腋动脉TAVI通过左腋动脉进行，15%通过右腋动脉进行。手术成功率为95%。总体而言，这种方法有明显的学习曲线。没有患者发生重大并发症，11%的患者发生轻微入路部位并发症。有1例手术死亡（瓣环破裂）和1例围手术期短暂性脑缺血发作（TIA）。23%的患者接受了新的起搏器植入。出院时，有效瓣口面积为1.94±0.16平方厘米，平均主动脉瓣压差为6.8±2.1毫米汞柱。两名患者记录有中度主动脉瓣反流/瓣周漏。30天和1年的死亡率分别为6%和14.8%。最后但同样重要的是，第二代装置显示出更好的手术结果。
经皮经腋动脉途径进行TAVI在技术上是可行和安全的，从而产生了优异的临床结果。
我们对100例连续接受经皮经腋动脉经导管主动脉瓣植入术的患者进行了研究，结果表明该方法在技术上是可行和安全的，轻微血管并发症数量可接受。
