Author + information
- Received August 31, 2018
- Revision received October 18, 2018
- Accepted October 23, 2018
- Published online January 7, 2019.
- Joris F. Ooms, MD and
- Nicolas M. Van Mieghem, MD, PhD∗ ()
- Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Nicolas M. Van Mieghem, Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Room Rg-628, ’s Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.
An 80-year-old man with severe aortic stenosis and history of coronary artery bypass grafting and extensive peripheral artery disease underwent a failed transapical aortic valve implantation attempt complicated by apical tear and bleeding. A completely percutaneous transaxillary aortic valve implantation at a second stage was successful. After local anesthesia of the right deltopectoral groove, access to the right axillary artery was obtained under ultrasound-guided access (Figures 1A to 1E, Online Video 1). The arteriotomy depth was measured at 3 cm. A 16-F-equivalent 34-mm self-expanding Evolut XL transcatheter aortic valve (Medtronic, Minneapolis, Minnesota) was implanted with no residual paravalvular regurgitation (Figures 1F and 1G). An 18-F collagen-based Manta device (Essential Medical, Malvern, Pennsylvania) achieved successful arteriotomy closure with immediate hemostasis (Figures 1H and 1I, Online Videos 2 and 3).
Local anesthesia allows complete and direct patient monitoring during the procedure, limits delirium incidence, and may shorten in-hospital stay. A potential disadvantage may be occasional temporary patient discomfort during the procedure.
Advantages over other alternative access routes include completely percutaneous access with no surgical cut-down in combination with visual monitoring and ability to control the access site at all times because the axillary artery is manually compressible against the humeral head. Shoulder discomfort and soreness may sometimes hamper post-procedural recovery.
Dr. Van Mieghem has received research grant support from Essential Medical. Dr. Ooms has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received August 31, 2018.
- Revision received October 18, 2018.
- Accepted October 23, 2018.
- 2019 American College of Cardiology Foundation