Key result
Alternative access routes for TAVI (transcarotid, trans-subclavian, transaortic) have specific strengths and weaknesses, with existing data insufficient to favor one approach over another.
Why the study?
What are the strengths and weaknesses of various alternative access routes for TAVI?
What are the strengths and weaknesses of various alternative access routes for TAVI?
This review highlights the shift away from transapical access for TAVI and emphasizes the potential of trans-subclavian access as the primary alternative, despite a difficult learning curve.
Alternative TAVI access selection should remain individualized; leaves open head-to-head trials to identify optimal routes.
Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.
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Overtchouk et al. (2018) conducted a review in Transcatheter aortic valve implantation (TAVI) requiring alternative access. Alternative access routes for TAVI (transcarotid, trans-subclavian, transaortic, transcaval) was evaluated. Alternative access routes for TAVI (transcarotid, trans-subclavian, transaortic) have specific strengths and weaknesses, with existing data insufficient to favor one approach over another.
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