Alternative Access for TAVR: A State-of-the-Art Review and Practical Guide.

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Current guidelines for transcatheter aortic valve replacement (TAVR) primarily recommend transfemoral (TF) access.
• Advances in technology and technique have expanded TF access suitability, but its limits in complex anatomies are debated.
• Alternative transvascular routes are increasingly used for TAVR when TF access is not optimal, yet the best approach is unclear.

Purpose of the Study:

• To review alternative access strategies for TAVR.
• To discuss the decision-making process for choosing between TF and non-TF access.
• To outline key considerations for selecting and executing alternative TAVR access sites.

Main Methods:

• State-of-the-art review of current literature and practices.
• Analysis of decision-making algorithms for TAVR access.
• Discussion of alternative access site selection and procedural techniques.

Main Results:

• TF access is the preferred TAVR route, but its feasibility has limitations.
• Alternative transvascular access routes are viable options for select TAVR patients.
• Optimal selection and execution of alternative access are crucial for TAVR success.

Conclusions:

• Determining the threshold for TF access feasibility in TAVR is critical.
• Alternative access site selection requires careful consideration of patient anatomy and procedural factors.
• This review provides guidance on optimizing non-TF access for TAVR procedures.