Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Sep;13(3):145-150.
doi: 10.15420/icr.2018.22.1.

Alternate Access for TAVI: Stay Clear of the Chest

Pavel Overtchouk  1 , Thomas Modine  1
Affiliations
Review

Alternate Access for TAVI: Stay Clear of the Chest

Pavel Overtchouk et al. Interv Cardiol. 2018 Sep.

Abstract

Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15% of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another - between transcarotid, trans-subclavian and transaortic - because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.

Keywords: Alternative access; TAVI; TAVR; alternative approach; trans-subclavian; transaortic; transapical; transcarotid; transcaval.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Thomas Modine is a consultant for Boston Scientific, Medtronic, Edwards Lifesciences, Cephea, MicroPort Scientific Corporation, GE Healthcare and Abbott; he received a research support grant from Edwards Lifesciences. Pavel Overtchouk has no conflict of interest to declare.

Figures

Figure 1:
Figure 1:. Timing of published cohorts regarding alternative approaches for transcatheter aortic valve implantation and relative experience with respect to the abundance of data of each alternative approach
Figure 2:
Figure 2:. Overview of the alternative approaches
Figure 3:
Figure 3:. Timely variations of transcatheter aortic valve implantation approach usage in the French, United Kingdom, European and North American registries.[4,5,61–63]
Figure 4:
Figure 4:. Comparative 30-day all-cause mortality, stroke and life-threatening bleeding rates in high-risk patients treated with the different transcatheter aortic valve implantation approaches
Figure 5:
Figure 5:. Proposed algorithm for alternative approach selection
See this image and copyright information in PMC

References

    1. Leon MB, Smith CR, Mack MJ et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374((17):):1609–20. doi: 10.1056/NEJMoa1514616. - DOI - PubMed
    1. Nishimura RA, Otto CM, Bonow RO et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70((2):):252–89. doi: 10.1016/j.jacc.2017.03.011. - DOI - PubMed
    1. Baumgartner H, Falk V, Bax JJ et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38((36):):2739–91. doi: 10.1093/eurheartj/ehx391. - DOI - PubMed
    1. Grover FL, Vemulapalli S, Carroll JD et al. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. J Am Coll Cardiol. 2017;69((10):):1215–30. doi: 10.1016/j.jacc.2016.11.033. - DOI - PubMed
    1. Auffret V, Lefevre T, Van Belle E et al. Temporal Trends in Transcatheter Aortic Valve Replacement in France: FRANCE 2 to FRANCE TAVI. J Am Coll Cardiol. 2017;70((1):):42–55. doi: 10.1016/j.jacc.2017.04.053. - DOI - PubMed

LinkOut - more resources