Percutaneous Transaxillary versus Surgically- Assisted Transsubclavian TAVR: A Single Center Experience

Background: Transfemoral access is the standard approach for transcatheter aortic valve replacement (TAVR). However, an important proportion of TAVR patients may not be considered for transfemoral access because of anatomic reasons - for these patients, an alternative access route must be considered. The objective of this study was to assess the safety and efficacy of percutaneous transaxillary TAVR as compared to surgically assisted transsubclavian TAVR and to report the feasibility of next-day discharge following this percutaneous approach. Methods: Since January 2019, all transaxillary TAVR at our institution were performed using a standardized percutaneous approach - this was compared to our prior experience with transsubclavian TAVR via surgical cut down. Results: Sixty-four patients underwent transsubclavian/axillary TAVR since 2014: 40 surgically assisted transsubclavian (2014-2018) and 24 fully percutaneous transaxillary TAVR (2019-2020). Both groups had similar baseline characteristics. In the surgically assisted TAVR group, six major vascular complications were encountered and six patients were rehospitalized within 30 days after TAVR vs. no patients with a major vascular complication and one patient rehospitalized within 30 days in the percutaneous transaxillary group. Hospitalization was significantly shorter for patients treated by percutaneous vs. surgical approach (1.2 vs. 4.4 days; p < 0.001). Twenty out of 24 percutaneous transaxillary TAVR patients (83%) were discharged the day after TAVR. Conclusion: Percutaneous transaxillary TAVR is a safe and effective treatment option for patients not suitable for transfemoral TAVR. Significant reduction in hospital length-of-stay was noted in percutaneous transaxillary vs. surgically assisted transsubclavian TAVR.