While 80-90% of TAVI procedures use the transfemoral route, alternative access strategies like transapical, transaortic, transaxillary, and transcarotid approaches are required for complex anatomies.
This review summarizes alternative access routes for TAVI in patients with anatomical constraints precluding the standard transfemoral approach.
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.
Purmessur et al. (Thu,) conducted a review in severe aortic stenosis. Alternative surgical access strategies for TAVI was evaluated. While 80-90% of TAVI procedures use the transfemoral route, alternative access strategies like transapical, transaortic, transaxillary, and transcarotid approaches are required for complex anatomies.
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