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Updated: Jan 16, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Snare catheter technique in complex transcatheter aortic valve implantation procedures
Anthony Mezier1, Nicolas Combaret2, Andrea Innorta3
1Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; GCS Axium-Rambot, 13100 Aix-en-Provence, France.
Insights
A novel snare catheter technique successfully overcomes challenges in complex transcatheter aortic valve implantation (TAVI). This method aids valve advancement in difficult anatomies, improving TAVI procedure success rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter aortic valve implantation (TAVI) faces challenges due to complex patient anatomy, including calcified arteries, aortic arch variations, and native aortic valve conditions.
- Difficulties in advancing TAVI devices can lead to procedure failure or necessitate alternative, potentially riskier approaches.
Purpose of the Study:
- To present a successful strategy using a snare catheter for complex transcatheter aortic valve implantation (TAVI) cases where standard device advancement techniques failed.
- To highlight the utility of the snare catheter in overcoming specific TAVI procedural obstacles.
Main Methods:
- A retrospective review of 660 TAVI procedures identified five complex cases requiring a snare catheter for transcatheter heart valve (THV) advancement failure.
- Cases included difficulties crossing the aortic arch, navigating a horizontal aorta, overcoming severe aortic valve calcification, and managing obstruction by a prior bioprosthetic valve frame.
Main Results:
- The snare catheter technique successfully facilitated THV advancement in all five complex TAVI cases.
- Challenges addressed included traversing the aortic arch and horizontal aorta, and crossing both native and bioprosthetic aortic valves.
Conclusions:
- A snare catheter-based approach offers an effective solution for complex TAVI procedures, particularly when encountering anatomical or device-related advancement issues.
- This technique allows for successful TAVI in challenging scenarios, including those involving the aortic arch, horizontal aorta, native valve, or bioprosthetic valve, often from the standard access site.
Background:
Transcatheter aortic valve implantation is challenged by the anatomy and calcification of the arteries, aortic arch and aortic valve.
Aim:
To describe successful complex transcatheter aortic valve implantation with the use of a snare catheter, where other standard techniques have failed.
Methods:
From the database of 660 transcatheter aortic valve implantation procedures performed at the Clermont-Ferrand University Hospital between 01 February 2023 and 31 August 2024, we report the use of a snare catheter in five complex procedures with transcatheter heart valve advancement failure: two cases of failure to cross the aortic arch with a self-expandable transcatheter heart valve using standard techniques; one case of a horizontal aorta with failed advancement of a self-expandable transcatheter heart valve; a challenging case with significant calcification in the right coronary cusp impeding balloon-expandable transcatheter heart valve progression and crossing the native aortic valve; and another challenging case where the frame of an aortic bioprosthesis prevented the advancement of a self-expandable transcatheter heart valve.
Results:
During all these procedures, the use of a snare catheter enabled the challenges of advancement to be overcome, whether within the aortic arch or a horizontal aorta, or when there were difficulties in crossing a native aortic valve or a bioprosthetic aortic valve, thereby allowing the successful implantation of the transcatheter heart valve.
Conclusions:
The snare catheter strategy is an effective option for performing complex transcatheter aortic valve implantation procedures, specifically when crossing the aortic arch, a horizontal aorta, the aortic valve or an aortic bioprosthesis, and it is possible to use this technique while using the same access site for self-expandable transcatheter heart valve implantation.
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