Suprasternal and Left Axillary Transcatheter Aortic Valve Replacement in Morbidly Obese Patients.

Olds, Anna; Eudailey, Kyle; Nazif, Tamim; Vahl, Torsten; Khalique, Omar; Lewis, Clifton; Hahn, Rebecca; Leon, Martin et al. · Ann Thorac Surg · 2018

case_series · Level IV

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Abstract

In morbidly obese patients who cannot undergo transfemoral, transaortic, or transapical transcatheter aortic valve replacement (TAVR) due to body habitus, suprasternal (SS) and left subclavian/axillary artery (LSCLA) approaches may provide safe TAVR access. Nine morbidly obese patients with a body mass index of 35 or more underwent SS-TAVR (7 patients) or LSCLA-TAVR (2 patients) at two institutions from 2015 to 2017. Mean age was 69.4 ± 7.3 years, and mean body mass index was 50.3 ± 10.6. There were no deaths, valve reinterventions, or reoperations. Three patients required new pacemakers. In morbidly obese patients who are not candidates for the other approaches, SS-TAVR and LSCLA-TAVR allow easier vascular access and prevent the need for thoracotomy or sternotomy.

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