Right Transaxillary Transcatheter Aortic Valve Replacement Using the “Flip-n-flex” Technique

Abstract Background Right Transaxillary transcatheter aortic valve replacement (TAx-TAVR) is rarely performed due to challenging vascular tortuosity and unfavorable implantation angles. We explored this procedure using the newer-generation balloon-expandable SAPIEN3 valve and our novel “flip-n-flex” technique. The safety and effectiveness of the procedure and the learning curve of our early experiences were investigated. Methods The first 10 consecutive right TAx-TAVR cases performed at our center from June 2016 to May 2018 were included in the study. Patients’ preoperative characteristics, procedural outcomes, and clinical outcomes were studied. Intraoperative fluoroscopy times were also reviewed to analyze the procedural learning curve. Results Mean age of the patient cohort was 81.8 ± 8.7 years and 5/10 (50%) patients were female. Mean STS-PROM was 12.0 ± 9.5%. Procedural success was achieved in all cases without vascular complications. Paravalvular leak was absent or mild in all patients. Two patients (20%) required permanent pacemaker implantation. The median postoperative length of stay was 4 days (range 2-13 days). The 30-day mortality was 0%. Mean transvalvular gradient improved from 38.4 ± 12.6 to 9 ± 4.4 mmHg postoperatively. New York Heart Association classification improved in all patients. The fluoroscopy time showed marked reduction from 44.1±8.2 min to 17.4±2.9 min with the use of the “flip-n-flex” technique. Conclusions Our early experience of right TAx-TAVR with the SAPIEN3 valve demonstrated satisfactory outcomes and a quick learning as facilitated by the “flip-n-flex” technique. This could be a beneficial TAVR approach to suitable patients.