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A feasibility study of transaxillary TAVI with the lotus valve

Mamas

A feasibility study of transaxillary TAVI with the lotus valve Thumbnail


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Abstract

Objectives
To assess the feasibility of axillary transcatheter aortic valve implantation (TAVI) using the Lotus valve.

Background
TAVI is used to treat patients with severe aortic stenosis, with transfemoral (TF) access being the safest and most widely used route. In patients unsuitable for this, there are reports that the axillary artery may be safest alternative access route. The Lotus device is a fully retrievable 2nd generation transcatheter heart valve which is licensed for femoral and transaortic access. There are limited data on the suitability of this valve for axillary access.

Methods
We assessed the feasibility of transaxillary TAVI with the Lotus valve in patients unsuitable for TF TAVI. Between January and October 2016, we identified 10 patients who underwent transaxillary TAVI with the Lotus valve. This cohort was compared with 347 (85%) patients who underwent TF TAVI, 45 (11%) patients who underwent and trans-apical or direct-aortic TAVI and the total group of 16 (4%) patients who underwent axillary TAVI.

Results
Ten patients aged 75 years (69–83) underwent attempted TAVI with the Lotus via axillary access. Device success was 100%. In-hospital and 30-day mortality was zero. There were no neurological events, no major vascular complications and no myocardial infarctions. Four of 10 patients required a pacemaker post-TAVI. No patient was left with moderate or greater aortic regurgitation. Median length of stay was 3 days

Conclusions
TAVI with the Lotus valve is feasible via the axillary artery and appears safe in our small cohort of patients.

Acceptance Date Oct 14, 2017
Publication Date Sep 1, 2018
Journal Catheterization and Cardiovascular Interventions
Print ISSN 1522-1946
Publisher Wiley
Pages 542 -549
DOI https://doi.org/10.1002/ccd.27409
Keywords aortic valve disease; structural heart disease intervention; transcatheter valve intervention
Publisher URL https://doi.org/10.1002/ccd.27409

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