Current Trends in TAVI Access.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Surgical Innovation

Background:

• Transcatheter aortic valve implantation (TAVI) is a crucial procedure for aortic stenosis.
• Transfemoral access is optimal but not feasible for all patients.
• Alternative access routes are essential for expanding TAVI eligibility.

Purpose of the Study:

• To compare the safety and efficacy of current alternative TAVI approaches.
• To review literature on various TAVI access routes beyond transfemoral.
• To inform clinical decision-making for TAVI in complex patient populations.

Main Methods:

• Systematic literature review of alternative TAVI access strategies.
• Analysis of transapical, transaortic, transsubclavian, transcarotid, transcaval, and suprasternal approaches.
• Evaluation of safety and efficacy data from published studies.

Main Results:

• Alternative TAVI approaches demonstrate feasibility in select patient groups.
• Safety and efficacy vary among different alternative access routes.
• Patient and institutional factors influence the choice of alternative TAVI approach.

Conclusions:

• Alternative TAVI approaches expand treatment options for patients ineligible for transfemoral access.
• The selection of an alternative approach requires careful consideration of patient-specific and access-specific factors.
• Further research is necessary to determine the long-term outcomes of individual alternative TAVI approaches.