Related Experiment Video
Updated: Oct 17, 2025
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Clinical Outcome and Safety of Transcaval Access for Transcatheter Aortic Valve Replacement as Compared to Other
Israel M Barbash1, Amit Segev1, Anat Berkovitch1
1Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel.
Insights
Transcaval access is a safe alternative for transcatheter aortic valve replacement (TAVR) in patients unsuitable for transfemoral TAVR. This approach shows reduced acute kidney injury and shorter hospital stays compared to other alternative methods.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Surgical Innovation
Background:
- Transcatheter aortic valve replacement (TAVR) is a critical procedure for aortic stenosis.
- Peripheral artery disease can preclude the standard transfemoral approach for TAVR.
- Alternative access routes for TAVR carry inherent risks; transcaval access is a novel option.
Purpose of the Study:
- To evaluate the safety and efficacy of the transcaval access technique for TAVR.
- To compare transcaval access with other alternative TAVR access methods (axillary, apical).
Main Methods:
- Retrospective analysis of 185 patients undergoing alternative access TAVR at a single center.
- Patients were divided into transcaval access (n=20) and other alternative access (n=165) groups.
- Outcomes adjudicated using Valve Academic Research Consortium-2 (VARC-2) criteria.
Main Results:
- TAVR device success was similar between groups (95%).
- Transcaval access demonstrated significantly lower rates of acute kidney injury (5% vs. 12%, p=0.05).
- Hospital stay was shorter for transcaval access patients (6.3 days vs. 14.4 days, p<0.001).
Conclusions:
- Transcaval access is a safe and effective alternative for TAVR in patients with contraindications to transfemoral access.
- The transcaval approach is associated with reduced risks of acute kidney injury and shorter hospitalizations.
- This technique offers a viable option for complex TAVR cases.
Abstract:
Background: A small proportion of patients in need of transcatheter aortic valve replacement (TAVR) are not suitable for the transfemoral approach due to peripheral artery disease. Alternative TAVR approaches are associated with short- and long-term hazards. A novel technique of caval-aortic (transcaval) access for TAVR has been utilized as an alternative access technique. Aim: To compare safety and efficacy of transcaval access as compared to other alternative access (axillary or apical) for TAVR. Methods: A single-center, retrospective analysis of consecutive patients undergoing alternative access for TAVR. Events were adjudicated according to VARC-2 criteria. Results: A total of 185 patients were included in the present analysis. Mean age was 81 years with a small majority for male gender (54%). Of the entire cohort, 20 patients (12%) underwent transcaval TAVR, and 165 patients (82%) underwent TAVR using alternative access. Overall, baseline characteristics were comparable between the two groups. General anesthesia was not utilized in transcaval patients; however, it was routinely used in nearly all alternative access patients. TAVR device success was comparable between the two groups (95%). Acute kidney injury occurred significantly less frequently among transcaval patients as compared to alternative access patients (5 vs. 12%, p = 0.05). Hospital stay was shorter for transcaval patients (6.3 days vs. 14.4; p < 0.001). No difference in early or 30-day mortality (10 vs. 7.9%, p = 0.74) was noted between groups. Conclusions: In patients who cannot undergo TAVR via the trans-femoral approach due to peripheral vascular disease, transcaval access is a safe approach as compared to other alternative access techniques, with lower risk of kidney injury and shorter hospital stay.
