Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement

ABSTRACT

Improvements in catheter technology make the transfemoral approach for transcatheter aortic valve replacement (TAVR) possible in approximately 95% of patients. Whilst alternative access is required in only a small proportion of patients, the rapid increase in the numbers of TAVR performed worldwide makes these approaches more frequent. Transthoracic approaches have been the traditional alternative to transfemoral access for TAVR; more recently, other approaches have been sought in an effort to reduce the excess rates of complications and mortality associated with transthoracic access. Herein, we review contemporary alternatives to transfemoral access for TAVR, including transaxillary/subclavian, transcarotid, and transcaval approaches.

KEYWORDS:

• TAVR
• aortic valve
• trans-subclavian
• trans-carotid
• trans-caval

Disclosure statement

Dr. Thourani is an advisor/research for Abbott Vascular, Boston Scientific, Gore Vascular, JenaValve, and Edwards Lifesciences. Dr. Meduri is an advisor for Boston Scientific, Medtronic and Admedus. Dr. Yadav is an advisor for Edwards Lifesciences.

Additional information

Funding

The authors report no funding in support of this paper.