Balloon-Assisted Transaxillary Artery Closure (BATAC): A Novel Vascular Closure Approach in Patients Undergoing TAVI Via Percutaneous Transaxillary Access.

Transaxillary (TAx) access has shown comparable outcomes to transfemoral access in selected studies of transcatheter aortic valve implantation (TAVI). Although TAx-TAVI has mainly been performed via surgical cutdown under general anesthesia, a fully percutaneous approach under local anesthesia with mild sedation has recently emerged as a less invasive option. We present Balloon-Assisted Transaxillary Artery Closure (BATAC) approach and report our early clinical experience. This observational study included consecutive adult patients with severe aortic stenosis who underwent simplified TAx-TAVI. Procedures were performed via left or right axillary access under ultrasound-guidance. Two ProStyles were predeployed, and the access sheath was progressively upsized over Amplatz Super Stiff wire. During closure, the Armada balloon was inflated at 2 atm via the ipsilateral arterial access at the site of the arteriotomy. With the balloon inflated, the ProStyle suture knots were sequentially advanced one-by-one under fluoroscopic guidance all the way to the arterial wall adjacent to the inflated balloon ensuring no entrapment within the surrounding soft tissue. Twelve patients underwent TAx-TAVI using this technique. Technical success was met in all patients, and device success in 91.7%. There were no in-hospital deaths, cerebrovascular events, major vascular complications, life-threatening bleeding, or need for vascular surgery. One patient developed cardiac tamponade requiring pericardial drainage, without transfusion. One minor access-site bleeding episode was managed conservatively. A simplified percutaneous axillary artery closure strategy following TAx-TAVI was associated with excellent early procedural and clinical outcomes in this small cohort. Larger studies are warranted to validate these findings.