Subclavian TAVI: more than an alternative access route

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Procedures

Background:

• Transcatheter aortic valve implantation (TAVI) is typically performed via the transfemoral retrograde route due to its minimally invasive nature.
• Alternative access routes including transapical, subclavian, and transaortic are utilized when transfemoral access is not feasible or poses risks.

Purpose of the Study:

• To evaluate the optimal vascular access strategy for TAVI when transfemoral access is contraindicated or high-risk.
• To advocate for the subclavian approach as a preferred alternative access route in specific TAVI patient populations.

Main Methods:

• Review of current TAVI vascular access techniques and their associated risks and benefits.
• Clinical judgment and Heart Team consensus on patient-centered vascular access selection.

Main Results:

• The transfemoral approach is standard but not always feasible or optimal.
• Subclavian access is presented as a favorable alternative due to lower invasiveness and potential for conscious sedation.
• No direct comparative studies exist, but clinical opinion favors subclavian access in select cases.

Conclusions:

• The subclavian approach should be strongly considered for TAVI patients with transfemoral contraindications or high vascular complication risk.
• Vascular access decisions for TAVI must be individualized by the Heart Team, prioritizing patient safety and outcomes over operator preference.