Direct Flow Medical TAVI FIRST SUBCLAVIAN IMPLANT

04 December 2014

The article by Dr. Bruschi et al describes the first case of trans-axillary direct flow implantation.

Direct Flow Medical TAVI FIRST SUBCLAVIAN IMPLANT

The article by Dr. Bruschi et al describes the first case of trans-axillary direct flow implantation. The case report was published in the International Journal of Cardiology 177 (2014) e176–e178.

The procedure was performed in a 87 yr old male with severe aortic stenosis with a mean gradient of 40mmHg, aortic valve area of 0.61 cm2/m2 and EF 42%. Due to calcified and small size femoral arteries a trans-axillary access was chosen. Case performed successfully with post-procedural mean gradient of 4 mmHg and trivial paravalvular leak by echo.

The authors outline the following positives aspects about the subclavian approach with DFM in this case:

  • very precise placement and excellent control of the DFM device (due to the short distance between the sheath and aortic annulus which also avoids contact with the aorta).
  • no interference with potentially calcified vascular surface or atheroma, translating in theoretical less embolization risk and higher valve control compared to the TF approach.

The authors acknowledge some limitations of this approach. In fact, the subclavian artery tissue is more fragile than that of femoral arteries and catheter handling should be performed with particular care. In addition,     valve retrieval (although not needed in this case) could prove complex in the limited space from the tip of the introducer to the aortic valve plane. A modified retrieval technique has been developed and tested successfully on the bench before attempting the case.

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