†These authors contributed equally.
Background: Transfemoral transcatheter aortic valve implantation (TAVI)
has proven non-inferior or superior against surgical aortic valve replacement
(SAVR) for patients at high, intermediate or low surgical risk. However,
transfemoral access is not always feasible in patients with severely
atherosclerotic or tortuous iliofemoral arteries. For these cases, alternative
access techniques have been developed, such as transcarotid, transcaval, direct
aortic or transaxillary access. In recent years, growing preference towards the
transaxillary access has emerged. To provide a summary of data
available on transaxillary TAVI and compare this approach to other alternative
access techniques. Methods: A literature search was performed in PubMed
by two independent reviewers. Studies reporting the outcome of at least 10
patients who underwent transaxillary TAVI, either in case series or in
comparative studies, were included in this review. Articles not reporting
outcomes according to the Valve Academic Research Consortium (VARC) 1–3
definitions were excluded. Results: In total 193 records were found of
which 18 were withheld for inclusion in this review. This review reports on the
combined data of the 1519 patients who underwent transaxillary TAVI. Procedural
success was achieved in 1203 (92.2%) of 1305 cases. Life-threatening,
major, and minor bleeding occurred respectively in 4.5% (n = 50 in 1112 cases),
12.9% (n = 143 in 1112 cases) and 8.8% (n = 86 in 978 cases). Major and minor
vascular complications were reported in respectively 6.6% (n = 83 in 1256 cases)
and 10.0% (n = 105 in 1048 cases) of patients. 30-day mortality was 5.2% (n =
76 out of 1457 cases). At one year follow-up, the mortality rate was 1% (n = 184
out of 1082 cases). Similar 30-day and 1-year mortality is observed in studies
that compare with transaxillary, transfemoral or other alternative access
techniques (p
