TRANSAXILLARY AORTIC VALVE REPLACEMENT AS AN ALTERNATIVE TO CURRENT TREATMENT METHODS

Mateusz Taranowicz; Monika Kowalska; Katarzyna Ścibisz; Dominika Zdobylak; Karolina Ollik; Kamil Harenza; Anita Zięba; Michał Domin; Justyna Całka; Olga Kowalczyk

doi:10.31435/ijitss.1(49).2026.5155

Authors

Mateusz Taranowicz 118th Military Hospital with Outpatient Clinic, SPZOZ, Ełk, Poland https://orcid.org/0009-0008-2233-055X
Monika Kowalska 4th Military Clinical Hospital with Outpatient Clinic, SPZOZ, Wrocław, Poland https://orcid.org/0009-0008-1930-6460
Katarzyna Ścibisz 1st Military Clinical Hospital with Outpatient Clinic, SPZOZ, Lublin, Poland https://orcid.org/0009-0003-0491-8783
Dominika Zdobylak 4th Military Clinical Hospital with Outpatient Clinic, SPZOZ, Wrocław, Poland https://orcid.org/0009-0009-5702-7136
Karolina Ollik 10th Military Clinical Hospital with Outpatient Clinic, SPZOZ, Bydgoszcz, Poland https://orcid.org/0009-0001-9577-9648
Kamil Harenza Mikołaj Pirogow Provincial Specialist Hospital, Łódź, Poland https://orcid.org/0009-0003-6200-4672
Anita Zięba 1st Military Clinical Hospital with Outpatient Clinic, SPZOZ, Lublin, Poland https://orcid.org/0009-0007-9075-6555
Michał Domin Stefan Cardinal Wyszyński Voivodeship Specialist Hospital, Lublin, Poland https://orcid.org/0009-0008-9081-8485
Justyna Całka 107th Military Hospital with Outpatient Clinic, SPZOZ, Wałcz, Poland https://orcid.org/0009-0006-9378-6920
Olga Kowalczyk Norbert Barlicki Memorial Teaching Hospital No. 1 of the Medical University of Lodz, Łódź, Poland https://orcid.org/0009-0007-4606-7736

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5155

Keywords:

Cardiac Surgery, Aortic Valve, Valve Replacement, Transaxillary Approach, Heart, TAVI, Sternotomy

Abstract

Introduction and aim: The aortic valve consists of three lobes, often presenting as a bilobed congenital heart defect. It is responsible for the outflow of blood from the left ventricle into the aorta by preventing backflow of blood into the heart during left ventricular diastole. The most common health problems associated with the aortic valve include stenosis and regurgitation. In minor defects, regular pharmacological treatment may be sufficient. In larger defects, these are available and necessary for treatment; they often require a mechanical valve. The aim of this paper is to review the availability of transaxillary access for aortic valve replacement as an emergency treatment method and its compatibility with current alternatives. The advantages and disadvantages of this treatment are highlighted.

Materials and Methods: This narrative review was based on a structured analysis of published clinical trials, extension studies, and review articles evaluating, clinical efficacy, complications in patients with surgical methods for aortic stenosis defects.

Results: A significant number of people with aortic valve disease can be managed with minimally invasive monitoring and do not require radical treatment. However, if the defect is severe, surgical treatment is necessary. Aortic valve replacement is currently treated using three basic methods. The first is a classic sternotomy, which involves opening the chest by splitting the sternum. The second method is percutaneous valve implantation: TAVI. Recently, thanks to the use of modern equipment, minimally invasive surgical techniques have become available, including: partial upper sternotomy, mini-sternotomy, and right anterior mini-thoracotomy. During surgery, two types of valves can be implanted: mechanical or biological. Each is preferred by different groups of patients and carries different consequences. Therefore, when qualifying for the procedure, it is crucial to consider the patient's preferences, as well as a thorough analysis of the clinical situation by a team of experts.

Conclusions: The transaxillary approach is a more invasive method than TAVI, but less invasive than the sternotomy approach. This allows for shorter recovery times after the procedure, with more thorough cleaning and valve adjustment than with TAVI. At the same time, this method requires greater operator dexterity, as access is limited compared to traditional incisions, both in terms of space for instruments and visibility.

References

Agarwal, S., Garg, A., Parashar, A., Svensson, L. G., Tuzcu, E. M., Navia, J. L., Mick, S., & Kapadia, S. R. (2015). In-hospital mortality and stroke after surgical aortic valve replacement: A nationwide perspective. The Journal of Thoracic and Cardiovascular Surgery, 150(3), 571–578.e8. https://doi.org/10.1016/j.jtcvs.2015.05.068

Auensen, A., Hussain, A. I., Bendz, B., Aaberge, L., Falk, R. S., Walle-Hansen, M. M., & others. (2017). Morbidity outcomes after surgical aortic valve replacement. Open Heart, 4, e000588. https://doi.org/10.1136/openhrt-2017-000588

Berdajs, D. A., Trampuz, A., Ferrari, E., Ruchat, P., Hurni, M., & von Segesser, L. K. (2011). Delayed primary versus late secondary wound closure in the treatment of postsurgical sternum osteomyelitis. Interactive Cardiovascular and Thoracic Surgery, 12(6), 914–918. https://doi.org/10.1510/icvts.2010.263483

Cordeiro, A. L. L., Gonçalves, E. S., Santana, R. M., & Santos, T. S. M. D. (2025). Transcatheter aortic valve implantation (TAVI) versus surgical valve replacement on clinical outcomes in patients with aortic stenosis. Arquivos Brasileiros de Cardiologia, 122(10), e20240295. https://doi.org/10.36660/abc.20240295

Curio, J., Guthoff, H., Nienaber, S., Wienemann, H., Baldus, S., Adam, M., & Mauri, V. (2025). Transcatheter aortic valve implantation indications and patient selection. Interventional Cardiology, 20, e19. https://doi.org/10.15420/icr.2024.44

Deblier, I., Dossche, K., Vanermen, A., & Mistiaen, W. (2025). Predictors for and consequences of acute kidney injury after surgical aortic valve replacement: An observational retrospective study. Journal of Clinical Medicine, 14(20), 7159. https://doi.org/10.3390/jcm14207159

Desai, P. V., Goel, S. S., Kleiman, N. S., & Reardon, M. J. (2023). Transcatheter aortic valve implantation: Long-term outcomes and durability. Methodist DeBakey Cardiovascular Journal, 19(3), 15–25. https://doi.org/10.14797/mdcvj.1201

ElBardissi, A. W., Shekar, P., Couper, G. S., & Cohn, L. H. (2011). Minimally invasive aortic valve replacement in octogenarian, high-risk, transcatheter aortic valve implantation candidates. The Journal of Thoracic and Cardiovascular Surgery, 141(2), 328–335. https://doi.org/10.1016/j.jtcvs.2010.08.056

Eltchaninoff, H., Prat, A., Gilard, M., & others. (2011). Transcatheter aortic valve implantation: Early results of the FRANCE registry. European Heart Journal, 32(2), 191–197. https://doi.org/10.1093/eurheartj/ehq261

Erkapic, D., De Rosa, S., Kelava, A., Lehmann, R., Fichtlscherer, S., Hohnloser, S. H., & others. (2012). Risk for permanent pacemaker after transcatheter aortic valve implantation: A comprehensive analysis of the literature. Journal of Cardiovascular Electrophysiology, 23(4), 391–397. https://doi.org/10.1111/j.1540-8167.2011.02211.x

Erkapic, D., Kim, W. K., Weber, M., & others. (2010). Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. Europace, 12(8), 1188–1190. https://doi.org/10.1093/europace/euq094

Foghsgaard, S., Schmidt, T. A., & Kjaergard, H. K. (2009). Minimally invasive aortic valve replacement: Late conversion to full sternotomy doubles operative time. Texas Heart Institute Journal, 36(4), 293–297.

Habib, G., Hoen, B., Tornos, P., Thuny, F., Prendergast, B., Vilacosta, I., Moreillon, P., de Jesus Antunes, M., Thilen, U., Lekakis, J., Lengyel, M., Müller, L., Naber, C. K., Nihoyannopoulos, P., Moritz, A., Zamorano, J. L., & ESC Committee for Practice Guidelines. (2009). Guidelines on the prevention, diagnosis, and treatment of infective endocarditis. European Heart Journal, 30(19), 2369–2413. https://doi.org/10.1093/eurheartj/ehp285

Gilmanov, D., Farneti, P. A., Ferrarini, M., Santarelli, F., Murzi, M., Miceli, A., Solinas, M., & Glauber, M. (2015). Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: A propensity-matched study. Interactive Cardiovascular and Thoracic Surgery, 20(6), 732–741. https://doi.org/10.1093/icvts/ivv030

Gilmanov, D., Solinas, M., Farneti, P. A., Cerillo, A. G., Kallushi, E., Santarelli, F., & Glauber, M. (2015). Minimally invasive aortic valve replacement: 12-year single center experience. Annals of Cardiothoracic Surgery, 4(2), 160–169. https://doi.org/10.3978/j.issn.2225-319X.2014.12.05

Harvey, J. E., III, Kapadia, S. R., Cohen, D. J., Kalra, A., Irish, W., Gunnarsson, C., Ryan, M., Chikermane, S. G., Thompson, C., & Puri, R. (2024). Trends in complications among patients undergoing aortic valve replacement in the United States. Journal of the American Heart Association, 13(17), e031461. https://doi.org/10.1161/JAHA.123.031461

Hayashida, K., Lefèvre, T., Chevalier, B., & others. (2012). True percutaneous approach for transfemoral aortic valve implantation using the Prostar XL device: Impact of learning curve on vascular complications. JACC: Cardiovascular Interventions, 5(2), 207–214. https://doi.org/10.1016/j.jcin.2011.09.020

Holzhey, D., Mohr, F. W., Walther, T., Möllmann, H., Beckmann, A., Kötting, J., Figulla, H. R., Cremer, J., Kuck, K. H., Lange, R., Sack, S., Schuler, G., Beyersdorf, F., Böhm, M., Heusch, G., Meinertz, T., Neumann, T., Papoutsis, K., Schneider, S., Welz, A., … Hamm, C. W. (2016). Current results of surgical aortic valve replacement: Insights from the German Aortic Valve Registry. The Annals of Thoracic Surgery, 101(2), 658–666. https://doi.org/10.1016/j.athoracsur.2015.07.090

Jensen, E. M., Larusdottir, K. J., Gunnarsdottir, E. L. T., Gunnarsdottir, S. L. X., Jeppsson, A., & Gudbjartsson, T. (2024). Laeknabladid, 110(5), 247–253. https://doi.org/10.17992/lbl.2024.05.792

Khawaja, M. Z., Thomas, M., Joshi, A., & others. (2012). The effects of VARC-defined acute kidney injury after transcatheter aortic valve implantation (TAVI) using the Edwards bioprosthesis. EuroIntervention. https://doi.org/10.4244/EIJV8I5A87

Koos, R., Mahnken, A. H., Aktug, O., Dohmen, G., Autschbach, R., Marx, N., & Hoffmann, R. (2011). Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. The Journal of Heart Valve Disease, 20(1), 83–90.

Kowalówka, A., Staromłyński, J., Mendrala, K., Kowalewski, M., Bachowski, R., & Gocol, R. (2025). Results of minimally invasive aortic valve replacement. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 22(4), 258–266. https://doi.org/10.5114/kitp.2025.158102

Ktenopoulos, N., Apostolos, A., Karanasos, A., Drakopoulou, M., Katsaros, O., Simopoulou, C., Oikonomou, G., Kachrimanidis, I., Koliastasis, L., Benetos, G., Tsalamandris, S., Synetos, A., Latsios, G., Tsioufis, C., & Toutouzas, K. (2024). Safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with previous TAVI: A systematic review and meta-analysis. European Heart Journal, 45(Supplement_1), ehae666.2451. https://doi.org/10.1093/eurheartj/ehae666.2451

Lacquaniti, A., Ceresa, F., Campo, S., Smeriglio, A., Trombetta, D., Patanè, F., & Monardo, P. (2024). Surgical aortic valve replacement and renal dysfunction: From acute kidney injury to chronic disease. Journal of Clinical Medicine, 13(10), 2933. https://doi.org/10.3390/jcm13102933

Langanay, T., Rouzé, S., Tomasi, J., Aymami, M., Rehman, S. M., Anselmi, A., Corbineau, H., Flécher, E., Logeais, Y., Leguerrier, A., & Verhoye, J. P. (2018). Conventional aortic valve replacement in 2005 elderly patients: A 32-year experience. European Journal of Cardio-Thoracic Surgery, 54(3), 446–452. https://doi.org/10.1093/ejcts/ezy072

Moscoso Ludueña, M., & Rastan, A. J. (2015). Complications and conversions in minimally invasive aortic valve surgery. Annals of Cardiothoracic Surgery, 4(1), 94–98. https://doi.org/10.3978/j.issn.2225-319X.2014.11.14

Möllmann, H., Kempfert, J., Hamm, C. W., & others. (2010). Kathetergestützte Aortenklappenimplantation. Herz, 35, 62–68. https://doi.org/10.1007/s00059-010-3326-2

Naber, C. K., Ghanem, A., Abizaid, A. A., & others. (2012). First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation. EuroIntervention, 8(1), 43–50. https://doi.org/10.4244/EIJV8I1A8

Neely, R. C., Boskovski, M. T., Gosev, I., Kaneko, T., McGurk, S., Leacche, M., & Cohn, L. H. (2015). Minimally invasive aortic valve replacement versus aortic valve replacement through full sternotomy: The Brigham and Women’s Hospital experience. Annals of Cardiothoracic Surgery, 4(1), 38–48. https://doi.org/10.3978/j.issn.2225-319X.2014.08.13

Rezk, M., Taha, A., Nielsen, S. J., Martinsson, A., Bergfeldt, L., Gudbjartsson, T., Franzén, S., & Jeppsson, A. (2023). Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement. European Journal of Cardio-Thoracic Surgery, 63(5), ezad103. https://doi.org/10.1093/ejcts/ezad103

Roten, L., Stortecky, S., Scarcia, F., & others. (2012). Atrioventricular conduction after transcatheter aortic valve implantation and surgical aortic valve replacement. Journal of Cardiovascular Electrophysiology, 23(10), 1115–1122. https://doi.org/10.1111/j.1540-8167.2012.02354.x

Saia, F., Ciuca, C., Taglieri, N., & others. (2012). Acute kidney injury following transcatheter aortic valve implantation: Incidence, predictors and clinical outcome. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2012.10.029

Sajid, B., Farid, R., Affan, M., Abdullah, A., Zehra, D., Rahl, K., Wahaj, Z., Asad, A., Ghori, A. K., Jawaid, H., & Abbasher Hussien Mohamed Ahmed, K. (2025). Comparative outcomes of minimally invasive right anterior mini-thoracotomy vs conventional sternotomy in aortic valve replacement: A propensity matched meta-analysis. Annals of Medicine and Surgery, 87(11), 7539–7548. https://doi.org/10.1097/MS9.0000000000003870

Schroeter, T., Linke, A., Haensig, M., Merk, D. R., Borger, M., Mohr, F. W., & Schuler, G. (2012). Predictors of permanent pacemaker implantation after Medtronic CoreValve bioprosthesis implantation. Europace, 14(12), 1759–1763. https://doi.org/10.1093/europace/eus191

Shi, W. Y., Malarczyk, A., Watson, R. A., Patel, P., Newell, P., Awtry, J., McGurk, S., & Kaneko, T. (2023). Impact of reintervention after index aortic valve replacement on the risk of subsequent mortality. JTCVS Open, 16, 93–102. https://doi.org/10.1016/j.xjon.2023.07.026

Smith, C. R., Leon, M. B., Mack, M. J., Miller, D. C., Moses, J. W., Svensson, L. G., Tuzcu, E. M., Webb, J. G., Fontana, G. P., Makkar, R. R., Williams, M., Dewey, T., Kapadia, S., Babaliaros, V., Thourani, V. H., Corso, P., Pichard, A. D., Bavaria, J. E., Herrmann, H. C., Akin, J. J., … PARTNER Trial Investigators. (2011). Transcatheter versus surgical aortic-valve replacement in high-risk patients. The New England Journal of Medicine, 364(23), 2187–2198. https://doi.org/10.1056/NEJMoa1103510

Squiccimarro, E., Margari, V., Visicchio, G., Kounakis, G., Pascarella, C., Carbone, C., & Paparella, D. (2024). Early results of minimally invasive aortic valve replacement via partial sternotomy or right thoracotomy: Insights in acute kidney injury. Journal of Cardiovascular Medicine, 25, e34. https://doi.org/10.2459/01.JCM.0001096524.21098.d0

Starvridis, D., Rad, A. A., Montanhesi, P. K., Kirov, H., Wacker, M., Tasoudis, P., Mukharyamov, M., Treml, R. E., Wippermann, J., Doenst, T., Sultan, I., Sá, M. P., & Caldonazo, T. (2025). Mini-sternotomy vs. right anterior mini-thoracotomy for surgical aortic valve replacement: A systematic review and meta-analysis. Brazilian Journal of Cardiovascular Surgery, 40(3), e20240211. https://doi.org/10.21470/1678-9741-2024-0211

Stoliński, J., Fijorek, K., Plicner, D., Grudzień, G., Kruszec, P., Musiał, R., & Andres, J. (2016). Perioperative outcomes of minimally invasive aortic valve replacement through right anterior minithoracotomy. The Thoracic and Cardiovascular Surgeon, 64(5), 392–399. https://doi.org/10.1055/s-0035-1566129

Stortecky, S., Wenaweser, P., Diehm, N., & others. (2012). Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation. JACC: Cardiovascular Interventions, 5(5), 515–524. https://doi.org/10.1016/j.jcin.2012.01.021

Stortecky, S., Windecker, S., Pilgrim, T., & others. (2012). Cerebrovascular accidents complicating transcatheter aortic valve implantation: Frequency, timing and impact on outcomes. EuroIntervention, 8(1), 62–70. https://doi.org/10.4244/EIJV8I1A11

Tchetche, D., Van der Boon, R. M., Dumonteil, N., & others. (2012). Adverse impact of bleeding and transfusion on the outcome post-transcatheter aortic valve implantation: Insights from the PRAGMATIC Plus initiative. American Heart Journal, 164(3), 402–409. https://doi.org/10.1016/j.ahj.2012.07.003

Thomas, M., Schymik, G., Walther, T., & others. (2011). One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome Registry. Circulation, 124(4), 425–433. https://doi.org/10.1161/CIRCULATIONAHA.110.001545

Wang, A., Athan, E., Pappas, P. A., & others. (2007). Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA, 297(12), 1354–1361. https://doi.org/10.1001/jama.297.12.1354