Key result
Contemporary alternatives to transfemoral access for TAVR, including transaxillary, transcarotid, and transcaval approaches, are reviewed to reduce complications associated with transthoracic access.
Why the study?
Alternative access approaches to transfemoral TAVR are increasingly needed, and alternatives to traditional transthoracic access have been sought to reduce complication and mortality rates.
What are the contemporary alternative access routes for TAVR in patients who cannot undergo transfemoral access?
What are the contemporary alternative access routes for TAVR in patients who cannot undergo transfemoral access?
This review highlights transaxillary/subclavian, transcarotid, and transcaval approaches as emerging alternatives to transthoracic access for TAVR when transfemoral access is not feasible.
Transaxillary, transcarotid, and transcaval access may be considered when transfemoral TAVR is infeasible; leaves open randomized comparisons versus transthoracic routes.
Improvements in catheter technology make the transfemoral approach for transcatheter aortic valve replacement (TAVR) possible in approximately 95% of patients. Whilst alternative access is required in only a small proportion of patients, the rapid increase in the numbers of TAVR performed worldwide makes these approaches more frequent. Transthoracic approaches have been the traditional alternative to transfemoral access for TAVR; more recently, other approaches have been sought in an effort to reduce the excess rates of complications and mortality associated with transthoracic access. Herein, we review contemporary alternatives to transfemoral access for TAVR, including transaxillary/subclavian, transcarotid, and transcaval approaches.
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Edelman et al. (2020) conducted a review in Transcatheter aortic valve replacement (TAVR). Alternative access for TAVR (transaxillary/subclavian, transcarotid, transcaval) vs. Transfemoral or transthoracic access was evaluated. Contemporary alternatives to transfemoral access for TAVR, including transaxillary, transcarotid, and transcaval approaches, are reviewed to reduce complications associated with transthoracic access.
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