Transaxillary Transcatheter Aortic Valve Replacement with a Self-Expanding Valve under Conscious Sedation: Case Discussion and Review of the Literature

Grubb KJ, Fields T, Cheng A, Settles DM, Stoddard M and Flaherty MP

Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine and Jewish
Hospital Rudd Heart and Lung Institute, USA
Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, USA
Department of Anesthesiology, Cardiac Anesthesiology, Jewish Hospital, USA
Division of Cardiovascular Medicine, University of Louisville School of Medicine, USA

^*Correspondance to: Kendra J. Grubb 

 PDF  Full Text DOI: 10.25107/2474-1647.1019

Abstract

Aortic stenosis is one of the leading causes of structural heart disease in the western world. Transcatheter aortic valve replacement (TAVR) has become the procedure of choice for patients deemed high-risk or inoperable for traditional aortic valve replacement and is rapidly proving to be suitable for lower risk patients. The technology has transformed the management of aortic stenosis. With growing expertise and more advanced devices, established TAVR programs have adopted a minimalist approach to TAVR and now routinely perform the transfemoral procedure on patients with only local anesthetic and monitored anesthesia care (MAC) to facilitate a totally percutaneous technique. For patients with inadequate iliofemoral access, the risk of vascular injury is extremely high and alternative techniques have been utilized and include the transapical, transaortic, and transsubclavian or transaxillary routes. Alternative approaches often require open surgical exposure under general anesthesia.Herein we describe a unique transaxillary TAVR with a self-expanding device utilizing only local anesthesia and MAC. To our knowledge, this is the first case in the United States to describe an awake TAVR with an axillary artery cut down.

Keywords

Transcatheter aortic valve replacement (TAVR); Transcatheter aortic valve implantation (TAVI); Transcatheter heart valve (THV); Transsubclavian; Transaxillary; Minimalist TAVR

Cite the article

Grubb KJ, Fields T, Cheng A, Settles DM, Stoddard M, Flaherty MP. Transaxillary Transcatheter Aortic Valve Replacement with a Self-Expanding Valve under Conscious Sedation: Case Discussion and Review of the Literature. Clin Surg. 2016; 1: 1019.