Presentation

Fully Percutaneous Transaxillary Transcatheter Aortic Valve Implantation in patients with a patent left internal mammary graft

We report a clinical experience with fully percutaneous transaxillary TAVI in patients with a patent left internal mammary graft.

Comments

    Thank you Hirofumi Ohtani for your tremendous presentation. I totally agree with the potential for a valuable arterial access. Your experience is also important for CMD-BEVAR or T-branch Devices.

    One question: would it be possible to use Prostar XL instead of ProGlide if the vessel diameter is big enough?

    Regards

    Hirofumi Ohtani
    June 12, 2018

    thank you for the question:
    in our practice we use 2 proglide’s instead of 1 prostar because we prefer nylon sutures and the trauma to the vessel wall is smaller with the proglide.

    Thank you for your answer and the enlightening presentation.

    Excellent presentation of a challenging case. I have only 2 questions:
    1) Do you have any concerns regarding the deployment of a balloon expandable covered stent in an area exposed to high mechanical stress?
    2) Median nerve injury can be a major complication of a percutaneous transaxillary access. Which is your strategy/approach in order to avoid it?

    Hirofumi Ohtani
    June 12, 2018

    Thank you for the questions.
    1) selfexpandable stents as viaban or fluency are definitely preferable. At the moment of the interventions we did not have the correct size. Corrective action: Now we have them on the shelf!!!
    2) to puncture under eco and fluoro+contrast guidance in the more distal portion of the axillary artery. Also, theoretically, the proglide pre-closure is little traumatic to the vessel.

    . Vascupedia
    September 18, 2018

    Aortic Disease Awareness Day – Please comment

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