ORIGINAL ARTICLE   

Panminerva Medica 2022 December;64(4):427-37

DOI: 10.23736/S0031-0808.22.04750-4

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Percutaneous vs. surgical axillary access for transcatheter aortic valve implantation: the TAXI registry

Arturo GIORDANO ¹, Andreas SCHAEFER ², Oliver D. BHADRA ², Lenard CONRADI ², Dirk WESTERMANN ³, Ole DE BACKER ⁴, Vilhelmas BAJORAS ⁴, Lars SONDERGAARD ⁴, Waqas T. QURESHI ⁵, Nikolaos KAKOUROS ⁵, Summer ALDRUGH ⁵, Ignacio AMAT-SANTOS ⁶, Sandra SANTOS MARTÍNEZ ⁶, Tsuyoshi KANEKO ⁷, Morgan HARLOFF ⁷, Rui TELES ⁸, Tiago NOLASCO ⁸, Jose P. NEVES ⁸, Miguel ABECASIS ⁸, Nikos WERNER ⁹, Michael LAUTERBACH ⁹, Jerzy SACHA ¹⁰, Krzysztof KRAWCZYK ¹⁰, Carlo TRANI ¹¹, Enrico ROMAGNOLI ¹¹, Antonio MANGIERI ^{12, 13}, Francesco CONDELLO ^{12, 13}, Ander REGUEIRO ¹⁴, Salvatore BRUGALETTA ^{13, 14}, Fausto BIANCARI ^{15, 16}, Matti NIEMELÄ ¹⁷, Francesco GIANNINI ¹⁶, Marco TOSELLI ¹⁸, Rossella RUGGIERO ¹⁸, Andrea BUONO ¹⁹, Diego MAFFEO ¹⁹, Francesco BRUNO ²⁰, Federico CONROTTO ²⁰, Fabrizio D’ASCENZO ²⁰, Mikko SAVONTAUS ²¹, Jouni PYKÄRI ²¹, Alfonso IELASI ²², Maurizio TESPILI ²², Nicola CORCIONE ¹, Paolo FERRARO ²³, Alberto MORELLO ¹, Michele ALBANESE ²³, Giuseppe BIONDI-ZOCCAI ^{24, 25} ✉

¹ Unit of Interventional Cardiology, Pineta Grande Hospital, Castel Volturno, Caserta, Italy; ² Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany; ³ Department of Cardiology, University Heart and Vascular Center of Hamburg, Hamburg, Germany; ⁴ The Heart Center - Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; ⁵ Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA; ⁶ Department of Cardiology, CIBERCV, University Clinical Hospital of Valladolid, Valladolid, Spain; ⁷ Division of Cardiac Surgery, Department of Surgery, Brigham and Women’s Hospital, Medical School of Harvard, Boston, MA, USA; ⁸ Department of Cardiothoracic Surgery, Santa Cruz Hospital, Carnaxide, Lisbon, Portugal; ⁹ Department of Medicine3, Barmherzige Brüder Hospital, Trier, Germany; ¹⁰ Department of Cardiology, Institute of Medical Sciences, University Hospital of Opole, Opole, Poland; ¹¹ Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ¹² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; ¹³ Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy; ¹⁴ Cardiovascular Institute, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; ¹⁵ Clinica Montevergine, GVM Care & Research, Mercogliano, Avellino, Italy; ¹⁶ Heart and Lung Center, University Hospital of Helsinki, Helsinki, Finland; ¹⁷ Department of Internal Medicine, Oulu University Hospital, Oulu, Finland; ¹⁸ Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Ravenna, Italy; ¹⁹ Unit of Interventional Cardiology, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy; ²⁰ Division of Cardiology, Department of Medical Science, Città Della Salute e della Scienza, Turin, Italy; ²¹ Heart Center, Turku University Hospital, Turku, Finland; ²² Unit of Clinical and Interventional Cardiology, Sant’Ambrogio Clinical Institute, Gruppo Ospedaliero San Donato, Milan, Italy; ²³ Unit of Interventional Cardiology, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy; ²⁴ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; ²⁵ Mediterranea Cardiocentro, Naples, Italy

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established management strategy for severe aortic valve stenosis. Percutaneous axillary approach for TAVI holds the promise of improving safety without jeopardizing effectiveness in comparison to surgical access. We aimed at appraising the comparative effectiveness of percutaneous vs. surgical axillary approaches for TAVI.
METHODS: We performed an international retrospective observational study using de-identified details on baseline, procedural, and 1-month follow-up features. Valve Academic Research Consortium (VARC)-3 criteria were applied throughout. Outcomes of interest were clinical events up to 1 month of follow-up, compared with unadjusted and propensity score-adjusted analyses.
RESULTS: A total of 432 patients were included, 189 (43.8%) receiving surgical access, and 243 (56.2%) undergoing percutaneous access. Primary hemostasis failure was more common in the percutaneous group (13.2% vs. 4.2%, P<0.001), leading to more common use of covered stent implantation (13.2% vs. 3.7%, P<0.001). Irrespectively, percutaneous access was associated with shorter hospital stay (-2.6 days [95% confidence interval: -5.0; -0.1], P=0.038), a lower risk of major adverse events (a composite of death, myocardial infarction, stroke, type 3 bleeding, and major access-site related complication; odds ratio=0.44 [0.21; 0.95], P=0.036), major access-site non-vascular complications (odds ratio=0.21 [0.06; 0.77], P=0.018), and brachial plexus impairment (odds ratio=0.16 [0.03; 0.76], P=0.021), and shorter hospital stay (-2.6 days [-5.0; -0.1], P=0.038).
CONCLUSIONS: Percutaneous axillary access provides similar or better results than surgical access in patients undergoing TAVI with absolute or relative contraindications to femoral access.

KEY WORDS: Aortic valve stenosis; Axillary vein; Transcatheter aortic valve replacement