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The “Chimney approach” for transcatheter aortic valve implantation: A strategy for trans axillarian bareback approach in patients with no other access options
Author(s) -
Biasco L.,
De Backer O.,
Holme S.,
Søndergaard L.,
Jönsson A.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25840
Subject(s) - medicine , surgery , stenosis , femoral artery , coronary arteries , cardiology , artery
Aim to describe the procedural steps and to report the short term follow up of our initial experience with an axillarian bareback Dacron graft based technique that could potentially reduce the rate of vascular and ischemic complications during transcatheter aortic valve implantation in patients with contraindications to trans‐femoral approach and with patent left internal mammary arterial graft to left anterior descending coronary artery (LIMA‐LAD) or small caliber axillarian/subclavian arteries. Methods and Results Four patients were treated with TAVI implantation with a trans axillarian bareback approach. Three out of four had a patent LIMA‐LAD graft. In three patients, femoral approach was not considered as an option for the presence of diffuse peripheral vascular disease, while in one for the small caliber of iliac‐femoral arteries. All procedures were performed under general anaesthesia. No procedural complications occurred. Conclusions In this initial experience, the axillarian bareback approach technique allowed a safe and successful TAVI implant in a subgroup of patients with a high risk of procedural complications due to the presence of a patent LIMA‐LAD or vessels of small caliber. Considering the increasing number of patients referred for TAVI, in the next future the axillarian bareback approach could represent a safer alternative to direct cannulation in patients with severe aortic stenosis with no other access options. © 2015 Wiley Periodicals, Inc.