Axillary artery conduit formation for arterial access during transapical transcatheter aortic valve replacement

Pankaj Saxena, Kevin L. Greason, Rakesh M. Suri, Alberto Pochettino, David R. Holmes, Charanjit S. Rihal, Verghese Mathew

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background Transapical transcatheter valve replacement is a relatively new technique for select patients with aortic valve stenosis, most of whom have severe peripheral vascular disease. We report our experience with the use of a right axillary artery conduit for arterial access during transapical valve replacement. Methods We reviewed the records of 129 patients who underwent transapical transcatheter aortic valve replacement between November 2009 and August 2013. The study group included 26 (20.2%) patients who received a right axillary artery conduit for arterial access. Median age of the patients was 84 years (63 to 90), sex was female in seven (26.9%), and Society of Thoracic Surgeons predicted risk of mortality was 8.7% (1.8 to 21.2). Results Axillary artery conduit use was significantly more common during the first half of our operative experience (24/65 patients, 36.9%) in comparison to the second half (2/64 patients, 3.1%; p < 0.0001). Inadequate iliofemoral artery diameter for cardiopulmonary bypass support was present in six patients (23.1%) who received a conduit. All patients underwent successful placement of the axillary artery conduit and subsequent conduit access for catheter-based procedures. Cardiopulmonary bypass support was provided to five (19.2%) patients. Operative mortality occurred in three (11.5%) patients and complications in 12 (46.2%), neither of which were related to the axillary artery conduit. Conclusions Creation of an axillary artery conduit provides a safe arterial access platform for transapical transcatheter aortic valve replacement.

Original languageEnglish (US)
Pages (from-to)308-311
Number of pages4
JournalJournal of Cardiac Surgery
Volume29
Issue number3
DOIs
StatePublished - May 2014

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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