Departement of Cardiac Surgery of Artois, Centre Hospitalier de Lens et Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France.
Departement of Cardiology, Hôpital Privé de Bois Bernard, Ramsay Générale de Santé, France.
Semin Thorac Cardiovasc Surg. 2019 Summer;31(2):175-180. doi: 10.1053/j.semtcvs.2018.09.016. Epub 2018 Oct 4.
The axillary artery seems an interesting alternative in nonfemoral transaortic valve replacement (TAVR) patients. This study describes our experience with this technique and its short-term follow-up results. This is a retrospective single center study. All axillary TAVR performed in our department between 2015 and 2017 were included in the study. Mean follow-up was 13.2 ± 9.5 months. All reporting was done according to the VARC-2 criteria. During the period covered, 43 patients had an axillary TAVR. Most patients were men (62.7%), had a mean age of 83.9 ± 5.3 years and presented with EuroSCORE I, II, and STS score of 27.9 ± 13.5%, 5.6 ± 4.9%, and 7.7 ± 4.05%, respectively. Vascular access was successful in all patients with a higher frequency of left approach (69.7%, n = 30). Both Medtronic CoreValve 37.2% (n = 16) and Edwards Sapien3 62.8% (n = 27) valves were used. An apical Certitude delivery system was preferentially used (24/27) in the latter group. There were no reported instances of valve migration or need for a second valve implantation. A single case (2.3%) of arterial vascular complication was reported. Central neurologic morbidity was 2.3%. No patient experienced brachial plexus injury. A pacemaker was implanted in 18.6% of cases (n = 8), with no significant difference between the 2 valves patient groups (S3 14.8% vs CV 25%, P 0.67). The 30-day mortality was 6.9% (n = 3) and 1-year survival was 86% [95% CI 72.6, 93.4]. Axillary TAVR is associated with acceptable morbidity, mortality, and leads to satisfactory short-term clinical outcomes. It has the potential to become the main alternative access route in nonfemoral TAVR patients.
腋动脉似乎是一种在非股动脉经主动脉瓣置换术（TAVR）患者中很有前途的选择。本研究描述了我们使用该技术的经验及其短期随访结果。这是一项回顾性单中心研究。2015 年至 2017 年期间，我们部门进行的所有腋动脉 TAVR 均被纳入研究。平均随访时间为 13.2±9.5 个月。所有报告均根据 VARC-2 标准进行。在此期间，共有 43 名患者接受了腋动脉 TAVR。大多数患者为男性（62.7%），平均年龄为 83.9±5.3 岁，EuroSCORE I、II 和 STS 评分分别为 27.9±13.5%、5.6±4.9%和 7.7±4.05%。所有患者的血管入路均成功，左侧入路的频率更高（69.7%，n=30）。使用的瓣膜分别为美敦力 CoreValve 37.2%（n=16）和爱德华兹 Sapien3 62.8%（n=27）。后者组更倾向于使用心尖 Certitude 输送系统（24/27）。没有报告瓣膜迁移或需要再次植入瓣膜的情况。仅报告了 1 例（2.3%）动脉血管并发症。中枢神经系统发病率为 2.3%。没有患者发生臂丛神经损伤。18.6%的患者（n=8）植入了起搏器，两种瓣膜患者组之间无显著差异（S3 14.8%vs CV 25%，P=0.67）。30 天死亡率为 6.9%（n=3），1 年生存率为 86%[95%CI 72.6，93.4]。腋动脉 TAVR 相关的发病率、死亡率可接受，且可获得令人满意的短期临床结果。它有可能成为非股动脉 TAVR 患者的主要入路选择。
