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A Review of Alternative Access for Transcatheter Aortic Valve Replacement

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
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Abstract

With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus. While the majority of patients possess suitable anatomy for transfemoral arterial access, there is a subset of patients with extensive peripheral vascular disease that precludes this traditional approach to TAVR. Fortunately, innovation in the field of structural heart disease has led to the refinement of alternative access options for THV delivery. Selection of the most appropriate route of therapy mandates a careful consideration of multiple factors, including patient anatomy, technical feasibility, and equipment specifications. Furthermore, understanding the risks conferred by each access site for valve delivery—notably stroke, vascular injury, and major bleeding—is of paramount importance when selecting the approach that will best optimize the outcome for an individual. In this review, we provide a comprehensive summary of alternative approaches to transfemoral arterial TAVR as well as the available outcome data supporting each of these various techniques.

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Authors and Affiliations

  1. Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, GRB8, Boston, MA, 02114, USA

    Michael N. Young MD, Vikas Singh MBBS & Rahul Sakhuja MD, MPP, MSc

Authors
  1. Michael N. Young MD
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  2. Vikas Singh MBBS
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  3. Rahul Sakhuja MD, MPP, MSc
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Correspondence to Rahul Sakhuja MD, MPP, MSc.

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Michael Young and Vikas Singh each report no relevant conflict of interest to disclose.

Rahul Sakhuja serves as a consultant for Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Valvular Heart Disease

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Young, M.N., Singh, V. & Sakhuja, R. A Review of Alternative Access for Transcatheter Aortic Valve Replacement. Curr Treat Options Cardio Med 20, 62 (2018). https://doi.org/10.1007/s11936-018-0648-5

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