Abstract
Trans-subclavian (TSc) transcatheter aortic valve implantation (TAVI) is the leading alternate access approach for patients with severe aortic stenosis and anatomy prohibitive for transfemoral TAVI (Society of Thoracic Surgeons TVT Registry Special report 2021). Whilst effective, the TSc approach is plagued with technical difficulties, including sheath diameter restriction, delivery catheter length redundancy, and complex angulation when approaching the annular plane for deployment. Direct transaortic and transapical approaches are technically easier in this regard due to a shorter delivery system with a retroflex function; however, they carry significant morbidity. The Edwards Certitude delivery kit, marketed for transfemoral TAVI, was adopted in bilateral subclavian approaches and an Australasian unit’s novel experience and outcomes of using it are presented.
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