Key result
This state-of-the-art review outlines the decision-making process between transfemoral and alternative non-transfemoral access approaches for transcatheter aortic valve replacement.
Why the study?
Determining the threshold where transfemoral TAVR carries unacceptable risk remains controversial, and the optimal alternative access route in unsuitable patients is still debated.
This state-of-the-art review outlines the decision-making process and execution of alternative non-transfemoral access routes for TAVR in patients with complex vascular anatomies.
Refines TF feasibility thresholds in complex TAVR; leaves open randomized comparisons with alternative access.
Current guideline recommendations for transcatheter aortic valve replacement are largely confined to procedures performed via transfemoral (TF) access. Major advances in preprocedural planning, delivery system technology, and procedural technique have led to substantial growth in TF access, even in complex vascular anatomies. However, determining the threshold beyond which TF access is either not feasible or carries unacceptable risk remains controversial. Furthermore, although alternative transvascular access routes have largely replaced surgical transthoracic approaches in patients unsuitable for TF access, the optimal alternative access route is still debated. Herein, the authors provide a state-of-the-art review of alternative access for TAVR, including the decision-making process between TF and non-TF approaches and the key elements of alternative access site selection and execution.
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Feistritzer et al. (2025) conducted a review in Transcatheter aortic valve replacement (TAVR). Alternative access for TAVR vs. Transfemoral (TF) access was evaluated. This state-of-the-art review outlines the decision-making process between transfemoral and alternative non-transfemoral access approaches for transcatheter aortic valve replacement.
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