The transfemoral access is clearly the preferred approach to transcatheter aortic valve replacement (TAVR), followed by the trans-axillary or trans-subclavian. Despite the alternatives, some patients are still ineligible.

This study recently published in EuroIntervention reports initial experiences in Europe with the transfemoral transcaval approach. 

It included 50 patients from 5 centers assessed according to the VARC-2 definitions. all Patients presented high surgical risk and mean age was 78.7 ± 8.0 years (mean STS 6.1%).

The transcaval was successful in 49 of the 50 patients and the valve was successfully implanted in 94% of cases. Sealing of the aortic-cava puncture with a nitinol occluding device was successful in all cases with no need for emergency surgery. Only one patient was treated with a coated stent at aortic puncture level 24 hrs. after procedure due to a gradual hemoglobulin drop of (3 g/dl).

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VARC-2 life threatening bleeding and major vascular complications occurred in 4% and 10% of cases, respectively, for the transcaval access.

There were no cases of bleeding or vascular complications after discharge.

Conclusion

The transcaval approach proved to be feasible and safe for TAVR in high surgical risk patients with severe aortic stenosis that were not eligible for the conventional transfemoral approach or alternatives such as the trans-axillary or trans-subclavian. 

Original title: Feasibility and safety of transcaval transcatheter aortic valve implantation: a multicentre European registry.

Reference: Giulia Costa et al. EuroIntervention 2020;15:e1319-e1324.

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