Alternative access routes for transcatheter aortic valve implantation are required in 10-20% of patients and offer distinct advantages and disadvantages based on patient anatomy.
Provides a comprehensive overview of alternative access routes for TAVI in patients who cannot undergo standard transfemoral access.
Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.
Katsaros et al. (Fri,) conducted a review in Severe symptomatic aortic stenosis. Alternative access routes for transcatheter aortic valve implantation was evaluated. Alternative access routes for transcatheter aortic valve implantation are required in 10-20% of patients and offer distinct advantages and disadvantages based on patient anatomy.
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