Ipsilateral trans-axillary aortic valve replacement in a patient with ilio-femoral and coronary artery bypass surgery, permanent pacemaker and subclavian stent

Transcatheter aortic valve replacement (TAVR) has become the procedure of choice for patients deemed high-risk or inoperable for surgical aortic valve replacement. For patients with inadequate iliofemoral access, the risk of vascular injury is extremely high and alternative techniques have been utilized and include the transapical, transaortic and transsubclavian or transaxillary (TAx) routes. Alternative approaches often require open surgical exposure under general anesthesia. Herein, we describe a unique TAx TAVR with a balloon-expandable Edwards SAPIEN 3 device in a 77 year-old male patient with the history of coronary artery and ilio-femoral bypass surgery, permanent pacemaker implantation at the left pectoral fossa and left subclavian artery stent.