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Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

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Alternative Access for TAVR: Choosing the Right Pathway.

Katherine Lutz¹, Karla M Asturias¹, Jasmine Garg²

¹Division of Cardiology, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97201, USA.

Journal of Clinical Medicine

|June 27, 2024

Summary

This summary is machine-generated.

Transcatheter aortic valve replacement (TAVR) offers options beyond transfemoral access for severe aortic stenosis. This review analyzes alternative TAVR access routes and proposes a patient-centered algorithm for optimal selection.

Keywords:

alternative access transaortic transapical transaxillary transcarotid transcatheter aortic valve replacement transsubclavian vascular access

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Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Medical Technology

Background:

Severe aortic stenosis necessitates intervention, with transcatheter aortic valve replacement (TAVR) increasingly used, especially for high-risk patients.
Transfemoral access is the standard TAVR approach, but anatomical and comorbidity factors limit its applicability in some patients.

Purpose of the Study:

To review the evolution and current evidence of alternative vascular access routes for TAVR.
To propose a standardized algorithm for selecting the optimal alternative access method based on patient characteristics.

Main Methods:

Comprehensive literature review of common alternative TAVR access techniques (transapical, transaortic, transaxillary, etc.).
Analysis of the advantages, disadvantages, and patient-specific factors associated with each access route.
Development of a decision-making algorithm for optimal vascular access selection.

Main Results:

Multiple alternative TAVR access routes exist, each with unique benefits and drawbacks.
Patient comorbidities and specific anatomy are critical determinants for choosing an access strategy.
No universal algorithm currently exists for selecting the optimal alternative TAVR access.

Conclusions:

Tailoring vascular access to individual patient profiles is crucial for successful TAVR.
The proposed algorithm aims to standardize the selection of alternative access methods.
Further research and consensus are needed to refine TAVR access strategies.