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Percutaneous Transaxillary Transcatheter Aortic Valve Replacement: Case Series and Surgical Technique
Stephanie Stovall, Gordon Kritzer, Wayne Hwang, Gautam Velamoor, Drew Baldwin, Patricia Rantos, Robert Moraca.
Virginia Mason Franciscan Health, Seattle, WA, USA.

OBJECTIVE:
Transcatheter aortic valve replacement (TAVR) is the gold standard for aortic valve replacement (AVR) in patients with aortic stenosis (AS) deemed unsuitable for surgical AVR; however, approximately 35% of candidates have unsuitable iliofemoral anatomy and 25% have peripheral artery disease, which is associated with more complications and poorer clinical outcomes. Axillary artery access is an appealing alternative to femoral access in these patients due to its lower invasiveness compared to other non-femoral approaches.
METHODS:
In this single-center case series, we reviewed a TAVR database (2014-2020) of all patients with severe AS who underwent axillary TAVR. A retrospective analysis of prospectively curated demographic and clinical data were reviewed, and surgical techniques described.
RESULTS:
Eleven patients underwent axillary TAVR for severe AS, 91% of which were achieved via a percutaneous approach, respectively. 82% of patients were male with a mean age of 80 8.7 years (range: 60-90 years). The mean Society of Thoracic Surgeons (STS) risk score was 7.52 7.6% (range: 2.002-29.4%). The mean length of stay was 6.9 days (range: 1-26 days), with a mean ICU stay of 53.3 hours (range 15.2-336 hours). 30-day mortality was 0% and there were two post-operative complications, including a new left bundle branch block (n = 1) and major gastrointestinal bleeding (n = 1).
CONCLUSIONS:
We report the a single-center case series of patients with severe critical aortic stenosis undergoing axillary TAVR. Utilization of an axillary approach is safe and may reduce the risk of adverse outcomes of non-femoral TAVR. 


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