Transcatheter aortic valve implantation: alternative access options

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Calcific aortic valve stenosis is the most prevalent acquired valvular heart disease in adults.
• Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis in high-risk patients.
• Conventional TAVI approaches (transfemoral, transapical) are not suitable for all patients.

Purpose of the Study:

• To review and describe alternative access routes for transcatheter aortic valve implantation.
• To address the unmet need for TAVI in patients with prohibitive anatomy for standard approaches.

Main Methods:

• Review of recent literature and case reports on alternative TAVI access.
• Description of various alternative access techniques, including subclavian/axillary, ascending aorta, carotid, and brachiocephalic artery approaches.

Main Results:

• Several alternative access routes for TAVI have been described.
• These routes offer potential solutions for patients with challenging anatomy or comorbidities.
• Examples include subclavian/axillary artery, ascending aorta, carotid artery, and brachiocephalic artery access.

Conclusions:

• Alternative access routes expand TAVI eligibility for select patient groups.
• These novel approaches address limitations of traditional transfemoral and transapical TAVI.
• Further research and standardization of these alternative routes are warranted.