2023 Volume 56 Issue 6 Pages 233-242
When performing transcatheter aortic valve implantation (TAVI) in hemodialysis patients, a trans-femoral approach is often infeasible due to peripheral arterial disease. However, there are no sufficient data on the safety of a trans-subclavian approach ipsilateral to the dialysis shunt arm. In this report, we describe four cases of TAVI via the subclavian artery ipsilateral to the shunt arm. The patients were between 70 and 79 years old and had a dialysis shunt in the left forearm. All of them were considered to be at high risk for surgical aortic valve replacement (STS scores：6.292-12.624)；therefore, TAVI was performed after multidisciplinary heart team discussion. A left subclavian artery approach was selected because of iliac artery stenosis or severe calcification in the common femoral artery. The preprocedural aortic valve pressure gradient ranged from 30.2 to 44.2 mmHg；postprocedure, it decreased to 3.0-5.8 mmHg. After TAVI, all patients were able to undergo hemodialysis without shunt failure or subclavian artery stenosis. In these cases we have encountered, the postoperative hemodialysis course was uneventful, suggesting that TAVI via a trans-subclavian approach ipsilateral to the shunt arm can be performed safely.
