Brachiocephalic Artery Access Without Sternotomy in Older Asian Patients Undergoing Transcatheter Aortic Valve Replacement

Takehiko Matsuo; Takeshi Shimamoto; Yasushi Fuku; Masanobu Ohya; Kazushige Kadota; Tatsuhiko Komiya

doi:10.1016/j.jacasi.2024.03.006

Brachiocephalic Artery Access Without Sternotomy in Older Asian Patients Undergoing Transcatheter Aortic Valve Replacement

JACC Asia. 2024 May 14;4(6):495-499. doi: 10.1016/j.jacasi.2024.03.006. eCollection 2024 Jun.

Authors

Takehiko Matsuo^{1

2}, Takeshi Shimamoto¹, Yasushi Fuku³, Masanobu Ohya³, Kazushige Kadota³, Tatsuhiko Komiya¹

Affiliations

¹ Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
² Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
³ Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan.

Abstract

There are numerous approaches for transcatheter aortic valve replacement (TAVR); however, access-related complications remain a point of concern. We analyzed consecutive patients who underwent TAVR for severe aortic stenosis via the brachiocephalic artery (BCA) without sternotomy (TBc group, n = 10) and via the trans-ascending aortic (TAo group, n = 8). The median BCA diameter and distance between the access point and suprasternal notch or superior margin of the clavicle were 11.3 mm and 8.3 mm, respectively. No patients in the TBc group underwent a partial sternotomy. Compared with the TAo group, the TBc group exhibited a shorter mean procedure time and lower blood loss volume as well as shorter duration of hospitalization. TAVR through the BCA may be a safe and feasible alternative for ascending aorta access. Studies with longer follow-up analysis and more patients are warranted to confirm our findings.

Keywords: alternative access; aortic valve stenosis; brachiocephalic artery; innominate artery; transcatheter aortic valve replacement.