Transradial Secondary Arterial Access for Transcatheter Aortic Valve Implantation: Experience and Limitations

Objectives The transradial approach limits vascular complications in coronary interventions. The same may be true for transcatheter aortic valve implantation (TAVI). We present our experience using secondary transradial arterial access. Methods Secondary transradial arterial access has been our defa...

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Bibliographic Details
Published in:Heart, lung & circulation lung & circulation, 2015-07, Vol.24 (7), p.682-685
Main Authors: Wynne, Dylan G., MD, Rampat, Rajiv, MD, Trivedi, Uday, MD, de Belder, Adam, MD, Hill, Andrew, MD, Hutchinson, Nevil, MD, Hildick-Smith, David, MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Stenosis
Aortic Valve
Aortic Valve Stenosis - surgery
Cardiovascular
Female
Femoral Artery
Humans
Male
Outcome of TAVI
Radial access
Radial Artery
Retrospective Studies
Transcatheter aortic valve
Transcatheter Aortic Valve Replacement - methods
Vascular complication
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Summary:Objectives The transradial approach limits vascular complications in coronary interventions. The same may be true for transcatheter aortic valve implantation (TAVI). We present our experience using secondary transradial arterial access. Methods Secondary transradial arterial access has been our default strategy for TAVI since 2007. Procedural data is collected prospectively. We assessed procedural success and complications. Results Data from 282 patients aged 81 ± 5.2yrs was examined. Secondary arterial access was transradial (74%), femoral (24%) and none (2%). Secondary femoral access was reserved for failed radial access (3%), anatomical anomalies (4%), operator preference (7%), trial requirements (6%) or proctor preference (4%). The principal pathology was aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination (2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian (3.9%) or transapical approaches (1.8%). Significant vascular complications occurred in 25 cases (9.4%), including surgical repair of a failed percutaneous closure device (n=16), ilio-femoral dissection (n=3), iliac perforations (n=3), plaque disruption (n=1) and false aneurysm (n=2), one of which was from the secondary femoral access site. There was no local vascular complication from the secondary radial site. Conclusions The transradial secondary access route for TAVI is safe and effective. The transradial route may limit vascular access complications from secondary transfemoral access.
ISSN:1443-9506
1444-2892
DOI:10.1016/j.hlc.2014.12.011