The First Korean Patient With Severe Aortic Stenosis and Bilateral Iliofemoral Artery Disease Treated With Transcatheter Aortic Valve Implantation by Transsubclavian Approach

Abstract

Transcatheter aortic valve implantation (TAVI) is indicated as an alternative treatment modality to surgical aortic valve replacement for high risk patients. The standard retrograde approach through the femoral artery is not feasible in the case of unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). However, patients with aortic stenosis (AS) have a higher prevalence of for PAD because both diseases are consequences of atherosclerotic degenerative changes. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this report, we present the first Korean patient with symptomatic severe AS and bilateral iliofemoral artery disease who was successfully treated with TAVI using a CoreValve (Medtronic, Minneapolis, MN, USA) by transsubclavian approach.

Transcatheter aortic valve replacement via a transsubclavian approach in a patient with severe aortic stenosis who had previously undergone kidney transplantation

“…[ 16 ] Many approaches for TAVR have been introduced, including transfemoral, [ 17 ] transapical, [ 18 ] transaortic, [ 19 ] and transsubclavian routes. [ 20 ] Among them, the transfemoral approach is the current gold standard for TAVR and is used for first-line access. [ 12 ] In contemporary guidelines, the feasibility of this vascular access route is one of the main features to be assessed when choosing between TAVR and SAVR.…”

“…In a meta-analysis of randomized clinical trials, the mortality rate for patients who underwent TF-TAVR was lower than for those who underwent SAVR, and TF-TAVR yielded lower risks of stroke, major bleeding, and atrial fibrillation, as well as a shorter hospital stay [16] . Many approaches for TAVR have been introduced, including transfemoral, [17] transapical, [18] transaortic, [19] and transsubclavian routes [20] . Among them, the transfemoral approach is the current gold standard for TAVR and is used for first-line access [12] .…”