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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transcutaneous aortic valve implantation: recent advances and future
Olav F M Sellevold1, Fabio Guarracino
1Norwegian University of Science and Technology, St Olavs University Hospital, Trondheim, Norway. olav.sellevold@ntnu.no
Current Opinion in Anaesthesiology
|November 13, 2009
Summary
Transcatheter aortic valve implantation offers a safe alternative for elderly patients with severe aortic stenosis who are poor surgical candidates. Patient selection and risk assessment are crucial for successful outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Severe aortic stenosis poses a significant risk, particularly in elderly patients.
- Traditional surgical aortic valve replacement may be denied to high-risk individuals.
Purpose of the Study:
- To review recent experiences and studies on transcatheter aortic valve implantation (TAVI).
- To evaluate TAVI as an alternative for elderly patients with severe aortic stenosis and high surgical risk.
Main Methods:
- Review of current literature and clinical experiences with TAVI systems (Edwards SAPIEN, Medtronic CoreValve).
- Discussion of patient selection criteria, including age and risk scores.
- Analysis of anesthesiological approaches based on procedural routes (transapical, transarterial).
Main Results:
- TAVI has emerged as a viable alternative to surgical valve replacement for high-risk patients.
- Two primary TAVI systems are available, each with specific procedural considerations.
- Anesthesiological management varies depending on the access route, with general anesthesia facilitating transesophageal echocardiography.
Conclusions:
- Patient selection for TAVI typically involves age over 70-75 years and a logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) >20%.
- The EuroSCORE may overestimate risk, necessitating careful consideration in patient selection.
- TAVI is projected to increase its role in managing aortic stenosis in the elderly, potentially impacting future cardiac surgery practices.