The Heart Valve Society

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The Subclavian Artery, An Alternative Route For TAVI, A Propensity-score Matched Analysis
Nicolas d'Ostrevy, Geraud Souteyrand, Bruno Pereira, Nicolas Combaret, Andrea Innorta, Kasra Azarnoush, Lionel Camilleri.
CHU G Montpied, Clermont-ferrand, France.

BACKGROUND: Trans-Femoral (TF) is the most widely used approach for Transcatheter Aortic Valve Implantation (TAVI). The Trans Sub-Clavian (TSC) -TAVI allows overcoming the possible contraindications. We conducted a single-center retrospective study of the prospectivly completed database FRANCE2, comparing perioperative morbidity and mortality for both TF-TAVI and TSC-TAVI.
METHODS: Patients with severe aortic stenosis proposed for TAVI were prospectively included. Only TF and TSC procedures were analyzed. Patients treated with an Edwards SAPIEN valve were not included. The primary outcome consisted of morbidity and allcause mortality during hospitalization, while secondary endpoints included postoperative morbidity and mortality causes, including all events occurring during hospitalization.
RESULTS: We included 212 patients (147 TF-TAVI and 65 TSC-TAVI). There were no differences in preoperative data aside from gender and peripheral artery disease. Postoperatively, moderate to severe aortic insufficiencies were equally distributed. There were 4 deaths in the TF-TAVI and 2 in the TSC-TAVI (p = NS). Patients were followed for an average of 1 year. Twenty-eight deaths were recorded (TF-TAVI : 19 and TSC-TAVI : 9 (p = NS)). A propensity score matching was performed. We found a correlation between approach and both complications and mortality, with an OddsRatio 0.58 [0.42 - 0.81] for the TSC-TAVI.
CONCLUSIONS: Our study highlights TSC-TAVI as a simple and straightforward alternative in case of contraindication. Finally, our experience tends to indicate that a multidisciplinary approach with optimal patient selection, allows an acceptable morbidity and mortality rate.


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