Author + information
- Received April 7, 2009
- Revision received June 1, 2009
- Accepted June 15, 2009
- Published online September 1, 2009.
- Chiara Fraccaro, MD⁎,⁎ (, )
- Massimo Napodano, MD⁎,
- Giuseppe Tarantini, MD, PhD⁎,
- Valeria Gasparetto, MD⁎,
- Gino Gerosa, MD†,
- Roberto Bianco, MD†,
- Raffaele Bonato, MD‡,
- Demetrio Pittarello, MD‡,
- Giambattista Isabella, MD⁎,
- Sabino Iliceto, MD, PhD⁎ and
- Angelo Ramondo, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Chiara Fraccaro, Department of Cardiac Thoracic and Vascular Sciences, University of Padova, 2 via Giustiniani, 35128, Padova, Italy
Objectives Our aim was to assess the safety and feasibility of the retrograde trans-subclavian approach to transcatheter aortic valve implantation (TAVI) in selected high-risk patients with aortic stenosis (AS) and severe peripheral vasculopathy.
Background TAVI is an emerging therapeutic option to treat inoperable/high-risk patients affected by symptomatic AS. However, these patients are also often affected by severe iliac-femoral arteriopathy, rendering the transfemoral approach unemployable for percutaneous revalving procedure.
Methods From among those patients in our department between May 2007 and December 2008, who were refused surgical aortic valve replacement because of high surgical risk and were ineligible for transfemoral percutaneous aortic valve replacement, we scheduled 3 for TAVI by the subclavian approach. Procedures were performed by a combined team of cardiologists, cardiac surgeons, and anesthetists in the catheterization laboratory. The III generation CoreValve Revalving System (CoreValve Inc., Irvine, California) with an 18-F delivery system was introduced in all cases by the left subclavian artery.
Results Prosthetic valves were successfully implanted in all 3 cases, leading to a fall in transvalvular gradient without significant paravalvular regurgitation. No intraprocedural or periprocedural complications occurred. Two patients developed an atrioventricular block requiring the implantation of a permanent pacemaker. All patients were discharged in asymptomatic status, with good prosthesis performance. No adverse events occurred within the 3-month follow-up.
Conclusions TAVI by subclavian retrograde approach seems safe and feasible in inoperable/high-risk patients with AS and peripheral vasculopathy, who are neither eligible for surgical valve replacement nor transfemoral percutaneous aortic valve implantation. Further studies are needed to evaluate the long-term efficacy of this new therapy.
This study was supported by ASEC (Associazione per lo Studio dell'Emodinamica e della Cardiologia). Dr. Ramondo is a physician proctor for CoreValve, Inc.
- Received April 7, 2009.
- Revision received June 1, 2009.
- Accepted June 15, 2009.
- American College of Cardiology Foundation