[Feasibility and safety of right subclavian access for Edwards Sapien 3 balloon-expandable transcatheter aortic valve implantation].

Despite the technical advancements in transcatheter aortic valve implantation (TAVI), this procedure in patients with peripheral artery disease remains challenging and requires a patient-tailored management by the Heart Team. In-depth assessment of the patient's vascular anatomy is of utmost importance for the management of TAVI procedures with the aim to use the less invasive approach according to the specific patient characteristics. The trans-subclavian approach should be the preferred option in patients with femoral arterial disease undergoing TAVI; however, self-expandable valves have potential limitations, as in case of ascending aorta dilation and high implantation. We present an elegant solution to overcome this challenging situation with good short- and mid-term outcome. A balloon-expandable Edwards Sapien 3 prosthesis was implanted by right subclavian surgical access using a multistep approach. The imaging controls showed good positioning with trivial paravalvular leak. The right subclavian approach for balloon-expandable TAVI implantation is feasible and safe when performed by skilled operators and can be a valid treatment strategy when no other options are available.