{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T22:47:25Z","timestamp":1780613245227,"version":"3.54.1"},"reference-count":17,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of M\u00fcnster"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Currently, the transfemoral approach is recognized as the primary method for accessing transcatheter aortic valve implantation (TAVI). However, alternative techniques are needed when the transfemoral access is not suitable. We proposed that a modified transaxillary approach through the distal left axillary artery is both viable and safe for conducting TAVI, potentially offering benefits for patients. Methods: From December 2018 to February 2024, a total of 24 patients (7 women, average age 77.9 \u00b1 8 years) received TAVI using transaxillary access via the left axillary artery. The participants suffered from symptomatic severe aortic stenosis and were deemed TAVI candidates with iliofemoral anatomy unsuitable for a transfemoral route. The patient group displayed a high perioperative risk profile, with significant peripheral artery disease or severe obstructive infrarenal aortic conditions. The implantation of the aortic prosthesis was carried out through the left distal axillary artery. A balloon-expandable valve was used in every instance. Results: In the examined cohort, the 30-day mortality rate was 4.2%. A new pacemaker was necessary for four patients (16.7%). One case exhibited a new moderate neurological dysfunction. Additionally, one patient required surgical revision of the access point due to ischemia. Conclusions: Our findings indicate that transaxillary TAVI via the distal left axillary artery has yielded encouraging outcomes. This approach is practicable and safe, does not prolong the procedure, minimizes surgical trauma, ensures excellent access regardless of chest anatomy, and is sparing for the brachial plexus. As a single-center pilot study, our findings require confirmation in larger, prospective cohorts with extended follow-up to fully validate the safety and long-term efficacy of this technique.<\/jats:p>","DOI":"10.3390\/jcm14145127","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T14:38:36Z","timestamp":1752849516000},"page":"5127","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Alternative Transaxillary Access for Transcatheter Aortic Valve Implantation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5784-5747","authenticated-orcid":false,"given":"Konrad","family":"Wisniewski","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8782-0401","authenticated-orcid":false,"given":"Gerrit","family":"Kaleschke","sequence":"additional","affiliation":[{"name":"Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"De-Torres-Alba","sequence":"additional","affiliation":[{"name":"Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Martens","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1813-7848","authenticated-orcid":false,"given":"Heinz","family":"Deschka","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","first-page":"524","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"75","author":"Vahanian","year":"2022","journal-title":"Rev. Esp. Cardiol. Engl. Ed."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Abdelnour, M.W., Patel, V., Patel, P.M., Kasel, A.M., and Frangieh, A.H. (2024). Alternative access in transcatheter aortic valve replacement\u2014An updated focused review. Front. Cardiovasc. Med., 11.","DOI":"10.3389\/fcvm.2024.1437626"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"510","DOI":"10.21037\/acs-2020-av-79","article-title":"A step-by-step guide to trans-axillary transcatheter aortic valve replacement","volume":"9","author":"Harloff","year":"2020","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.31083\/j.rcm2405150","article-title":"The Place of Transaxillary Access in Transcatheter Aortic Valve Implantation (TAVI) Compared to Alternative Routes\u2014A Systematic Review Article","volume":"24","author":"Herremans","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"131353","DOI":"10.1016\/j.ijcard.2023.131353","article-title":"Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis","volume":"394","author":"Rooijakkers","year":"2024","journal-title":"Int. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1177\/15569845231177055","article-title":"The 10 Commandments for Transaxillary TAVI","volume":"18","author":"Dreger","year":"2023","journal-title":"Innov. Technol. Tech. Cardiothorac. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.jacc.2021.02.038","article-title":"Valve Academic Research Consortium 3: Updated Endpoint Definitions for Aortic Valve Clinical Research","volume":"77","author":"Piazza","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","unstructured":"Ascher, E., and Haimovici, H. (2012). Haimovici\u2019s Vascular Surgery, Wiley-Blackwell. [6th ed.]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s11748-024-02015-z","article-title":"Right transaxillary transcatheter aortic valve replacement is comparable to left despite challenges","volume":"72","author":"McGrath","year":"2024","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jcin.2019.01.219","article-title":"Outcomes Following Subclavian and Axillary Artery Access for Transcatheter Aortic Valve Replacement","volume":"12","author":"Dahle","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ijcard.2017.01.010","article-title":"Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients","volume":"232","author":"Deuschl","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1007\/s00380-022-02082-3","article-title":"Percutaneous trans-axilla transcatheter aortic valve replacement","volume":"37","author":"Sugiura","year":"2022","journal-title":"Heart Vessels"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Muscoli, S., Cammalleri, V., Bonanni, M., Prandi, F.R., Sanseviero, A., Massaro, G., Di Luozzo, M., Chiocchi, M., Ascoli Marchetti, A., and Ippoliti, A. (2022). The Transaxillary Route as a Second Access Option in TAVI Procedures: Experience of a Single Centre. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148649"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1016\/j.jcin.2016.08.034","article-title":"Predictors of Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement With the SAPIEN 3","volume":"9","author":"Mauri","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_15","first-page":"143","article-title":"Predictors of pacemaker implantation after transcatheter aortic valve implantation according to kind of prosthesis and risk profile: A systematic review and contemporary meta-analysis","volume":"7","author":"Bruno","year":"2021","journal-title":"Eur. Heart J.-Qual. Care Clin. Outcomes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.jcct.2022.07.003","article-title":"Impact of membranous septum length on pacemaker need with different transcatheter aortic valve replacement systems: The INTERSECT registry","volume":"16","author":"Hokken","year":"2022","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_17","unstructured":"Wisniewski, K., Kaleschke, G., De Torres-Alba, F., Martens, S., and Deschka, H. (2025, January 15\u201317). The Alternative Transaxillary Access for Transcatheter Aortic Valve Implantation. Proceedings of the 54th annual congress of the German Society for Thoracic and Cardiovascular Surgery (DGTHG), Hamburg, Germany."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5127\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:12:18Z","timestamp":1760033538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/5127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,18]]},"references-count":17,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14145127"],"URL":"https:\/\/doi.org\/10.3390\/jcm14145127","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,18]]}}}