Lots of interesting abstracts and cases were submitted for TCTAP 2026. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge!
ABS20251113_0002
Feasibility of Minimalistic Approach in Alternative Access TAVR
By Jonathan Xinguo Fang, Pedro Villablanca
Presenter
Jonathan Xinguo Fang
Authors
Jonathan Xinguo Fang1, Pedro Villablanca1
Affiliation
Henry Ford Hospital, USA1
View Study Report
ABS20251113_0002
Minimalist TAVR
Feasibility of Minimalistic Approach in Alternative Access TAVR
Jonathan Xinguo Fang1, Pedro Villablanca1
Henry Ford Hospital, USA1
Background
There is an evolving interest in minimalism in transcatheter aortic valve replacement (TAVR). However, the feasibility of minimalism in percutaneous alternative access TAVR, including transaxillary and transcaval access, is lacking
Methods
We performed TAVR minimalistically with conscious sedation,over-the-wire pacing, fluoroscopy guidance, radial secondary access, and early discharge algorithm in 31 consecutive patients (17 transcaval and 14 tranaxillary) receiving TAVR. Balloon-assisted dry closure technique was used for transaxillary access sized by intravascular ultrasound. Technique modifications were used to enable secondary radial access, facilitating access and hemostasis in transcaval access, and providing a bailout option using low-profile balloons up to 22mm delivered transradially and covered stents that can be postdilated up to 16mm. Ipsilateral radial secondary access was used in tranaxillary group and left radial access in transcaval group with up to 8 French using a short sheath with ultrasound-guided access. Balloon-expandable valves and E-sheaths were used in 93.5% of patients and self-expanding valves in 6.5%. In the case of transcaval access using self-expanding valve, an 18 French long sheath with hemostatic valve was used.
Results
Mean age was 76±9 and STS score 8.1±4.1%. Median procedure time was 156 (130-180) minutes for transcaval and 142 (124-180) for transaxillary TAVR. Intraprocedural success and hemostasis were achieved in 100% of patients. At 30-day post-discharge, there was one cardiovascular mortality (3.2%) due to refractory heart failure and one (3.2%) due to a non-cardiac cause. There were no major cardiac structural complications, grade3-4 bleeding, or major vascular complications according to the Valvular Academic Research Consortium (VARC) 3 criteria. One patient required a sheath exchange during transcaval access owing to superior hinge calcification at the access point and a blood transfusion of 2 units. Complete heart block occurred in 2 patients, and stroke in one patient. The median time from procedure to discharge was 1 (1, 2) day.
Conclusion
A Minimalistic approach is feasible for percutaneousalternative access TAVR. Limitation: this was performed at a high-volume center for alternative access TAVR and may not be generalizable.