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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
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Transcatheter Aortic Valve Replacement Using Transaortic Access: Experience From the Multicenter, Multinational,
Vinayak Bapat1, Derk Frank2, Ricardo Cocchieri3
1St. Thomas' Hospital, London, United Kingdom.
JACC. Cardiovascular Interventions
|September 10, 2016
Summary
The Registry of the Utilization of the TAo-TAVR approach (ROUTE) found transaortic access to be a safe alternative for transcatheter aortic valve replacement. This study assessed its effectiveness and safety in high-risk patients, with a 30-day mortality of 6.1%.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is an alternative to surgical valve replacement for high-risk patients.
- Transfemoral access is common, while transapical access is used for patients unsuitable for transfemoral routes.
- Transaortic (TAo) access is a viable surgical option, but data on its effectiveness and safety are limited.
Purpose of the Study:
- To assess the effectiveness and safety of transaortic (TAo) access for TAVR procedures.
- To evaluate TAo-TAVR using Edwards SAPIEN XT or SAPIEN 3 valves.
- To establish data on TAo-TAVR through the prospective, observational ROUTE registry.
Main Methods:
- A multicenter, international, prospective, observational registry (ROUTE) was conducted.
- Data from 18 European centers were collected starting February 2013.
- 301 patients with severe calcific aortic stenosis undergoing TAo-TAVR were included, with 30-day mortality as the primary endpoint.
Main Results:
- Mean patient age was 81.7 years; Society of Thoracic Surgeons score was 9.0%.
- Valve success was 96.7%; 30-day mortality was 6.1% (procedure-related: 3.1%).
- Complications included major vascular events (3.4%), life-threatening bleeding (3.4%), and acute kidney injury (9.5%); 3.3% had moderate/severe paravalvular regurgitation.
Conclusions:
- Transaortic access for TAVR is a safe alternative to the transapical approach.
- The ROUTE registry provides valuable data on TAo-TAVR outcomes.
- Further research may confirm TAo-TAVR as a standard option for select patients.
