ArticleClinical research in cardiology : official journal of the German Cardiac Society2025
Non-femoral focused transaxillary access in TAVI: GARY data analysis and future trends.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Enabling Transfemoral TAVI Through a Hostile Abdominal Aortic Anatomy and a Migrated Mesenteric Stent Fragment: Review of the Literature and a Case Presentation.Life (Basel, Switzerland) · 2026Review
- Successful off-label use of vascular closure devices in fully percutaneous transaxillary aortic valve implantation.Open heart · 2026Article
- Ultrasound versus angiographic guided access in transfemoral TAVI: intra-operator evaluation of vascular and bleeding complications.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Current Trends and Future Challenges in Transcatheter Aortic Valve Implantation (TAVI): A Narrative Review.Journal of clinical medicine · 2026Review
- Transsubclavian versus transfemoral TAVR with self-expanding valves.Frontiers in cardiovascular medicine · 2026Article
- From Last Resort to Standard of Care: The Evolution and Future of Transcatheter Aortic Valve Implantation.Reviews in cardiovascular medicine · 2026Review
- Ten-Year Experience with a Transapical Approach for Transcatheter Aortic and Mitral Valve Implantation.Journal of cardiovascular development and disease · 2024Article
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15 authors.
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Abstract
backgroundIn patients not suitable for transfemoral transcatheter aortic valve implantation (TAVI), several access strategies can be chosen.
aimTo evaluate the use and patient outcomes of transaxillary (TAx), transapical (TA), and transaortic (TAo) as alternative access for TAVI in Germany; to further evaluate surgical cutdown vs. percutaneous TAx access.
methodsAll patients entered the German Aortic Valve Registry (GARY) between 2011 and 2019 who underwent non-transfemoral TAVI were included in this analysis. Patients with TA, TAo, or TAx TAVI were compared using a weighted propensity score model. Furthermore, a subgroup analysis was performed for TAx regarding the percutaneous or surgical cutdown approach.
resultsOverall, 9686 patients received a non-transfemoral access. A total of 8918 patients (92.1%) underwent TA, 398 (4.1%) TAo, and 370 (3.8%) TAx approaches. Within the TAx subgroup, 141 patients (38.1%) received subclavian cutdown, while 200 (54.1%) underwent a percutaneous approach. The TA patients had a significantly lower 30-day survival than TAx patients (TA 90.92% vs. TAx 95.59%, p = 0.006; TAo 92.22% vs. TAx 95.59%, p = 0.102). Comparing percutaneous and cutdown TAx approaches, no significant differences were seen. However, more vascular complications occurred (TA 1.8%, TAo 2.4%, TAx 12.2%; p < .001), and the hospital length of stay was shorter (TA 12.9 days, TAo 14.1 days, TAx 12 days; p < .001) after TAx access.
conclusionIt may be reasonable to consider TAx access first in patients not suitable for TF-TAVI, because the 30-day survival was higher compared with TA access and the 1-year survival was higher compared with TAo access. It remains important for the heart teams to offer alternative access modalities for patients not amenable to the standard TF-TAVI approaches.
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