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Updated: Apr 29, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Challenges and future opportunities for transcatheter aortic valve therapy
Martin B Leon1, Hemal Gada1, Gregory P Fontana2
1Center for Interventional Vascular Therapy, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY.
Transcatheter aortic valve replacement (TAVR) offers a less-invasive option for severe aortic stenosis. Ongoing advancements aim to improve TAVR outcomes and expand its use in various patient groups.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for severe aortic stenosis in high-risk individuals.
- Despite TAVR's clinical success, challenges and future opportunities persist.
Purpose of the Study:
- To review current challenges and future directions in Transcatheter Aortic Valve Replacement (TAVR).
- To highlight the importance of the heart valve team in TAVR decision-making.
Main Methods:
- Discussion of key considerations in TAVR case selection, including frailty and futility assessments.
- Review of controversial procedural aspects such as vascular access, valve sizing, and post-dilatation.
- Examination of TAVR-associated complications and areas for improvement.
Main Results:
- TAVR is a valuable therapy for aortic stenosis, but requires careful case selection by a heart valve team.
- Procedural controversies and complications like stroke, bleeding, and regurgitation need technological and procedural enhancements.
- New TAVR systems and accessory devices, including cerebral protection, are being developed to optimize outcomes.
Conclusions:
- Transcatheter aortic valve replacement (TAVR) is an important therapy for aortic stenosis.
- Recognizing current limitations and exploring future opportunities are crucial for improving TAVR clinical outcomes.
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