Wisniewski Konrad, Kaleschke Gerrit, De-Torres-Alba Fernando, Martens Sven, Deschka Heinz
Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany.
Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany.
J Clin Med. 2025 Jul 18;14(14):5127. doi: 10.3390/jcm14145127.
Currently, the transfemoral approach is recognized as the primary method for accessing transcatheter aortic valve implantation (TAVI). However, alternative techniques are needed when the transfemoral access is not suitable. We proposed that a modified transaxillary approach through the distal left axillary artery is both viable and safe for conducting TAVI, potentially offering benefits for patients. From December 2018 to February 2024, a total of 24 patients (7 women, average age 77.9 ± 8 years) received TAVI using transaxillary access via the left axillary artery. The participants suffered from symptomatic severe aortic stenosis and were deemed TAVI candidates with iliofemoral anatomy unsuitable for a transfemoral route. The patient group displayed a high perioperative risk profile, with significant peripheral artery disease or severe obstructive infrarenal aortic conditions. The implantation of the aortic prosthesis was carried out through the left distal axillary artery. A balloon-expandable valve was used in every instance. In the examined cohort, the 30-day mortality rate was 4.2%. A new pacemaker was necessary for four patients (16.7%). One case exhibited a new moderate neurological dysfunction. Additionally, one patient required surgical revision of the access point due to ischemia. Our findings indicate that transaxillary TAVI via the distal left axillary artery has yielded encouraging outcomes. This approach is practicable and safe, does not prolong the procedure, minimizes surgical trauma, ensures excellent access regardless of chest anatomy, and is sparing for the brachial plexus. As a single-center pilot study, our findings require confirmation in larger, prospective cohorts with extended follow-up to fully validate the safety and long-term efficacy of this technique.
目前，经股动脉途径被公认为是进行经导管主动脉瓣植入术（TAVI）的主要方法。然而，当经股动脉入路不适用时，就需要其他技术。我们提出，通过左腋动脉远端的改良经腋动脉途径进行TAVI是可行且安全的，可能会给患者带来益处。从2018年12月到2024年2月，共有24例患者（7名女性，平均年龄77.9±8岁）通过经左腋动脉的经腋动脉入路接受了TAVI。这些参与者患有有症状的严重主动脉瓣狭窄，并且由于髂股部解剖结构不适合经股动脉途径而被视为TAVI候选者。患者组显示出较高的围手术期风险特征，伴有严重的外周动脉疾病或严重的肾下主动脉梗阻情况。主动脉假体通过左腋动脉远端植入。每例均使用球囊扩张瓣膜。在所检查的队列中，30天死亡率为4.2%。4例患者（16.7%）需要植入新的起搏器。1例出现新的中度神经功能障碍。此外，1例患者因缺血需要对入路点进行手术修复。我们的研究结果表明，通过左腋动脉远端进行经腋动脉TAVI取得了令人鼓舞的结果。这种方法可行且安全，不会延长手术时间，将手术创伤降至最低，无论胸部解剖结构如何都能确保良好的入路，并且对臂丛神经影响较小。作为一项单中心试点研究，我们的研究结果需要在更大规模、有延长随访期的前瞻性队列中得到证实，以充分验证该技术的安全性和长期疗效。
