Key result
Alternative peripheral access sites for TAVR are increasingly preferred over transthoracic approaches, providing viable options for patients with peripheral arterial disease.
Why the study?
Although transfemoral access is preferred for TAVR, approximately 25% of patients have peripheral arterial disease, necessitating intravascular lithotripsy or alternative non-femoral access routes.
Alternative peripheral access sites and intravascular lithotripsy provide viable options for TAVR in patients with severe aortic stenosis and peripheral arterial disease who cannot undergo standard transfemoral access.
May support alternative peripheral access for TAVR in PAD; leaves open need for randomized trials versus transthoracic approaches.
Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise.
No takes yet. Share an insight, caveat, or question.
Payabyab et al. (2021) conducted a review in Severe aortic stenosis. Non-transfemoral Transcatheter Aortic Valve Replacement was evaluated. Alternative peripheral access sites for TAVR are increasingly preferred over transthoracic approaches, providing viable options for patients with peripheral arterial disease.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: