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Review
. 2023 Dec 22;11(1):4.
doi: 10.3390/jcdd11010004.

Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits

Odysseas Katsaros  1 , Anastasios Apostolos  1 , Nikolaos Ktenopoulos  1 , Leonidas Koliastasis  1   2 , Ioannis Kachrimanidis  1 , Maria Drakopoulou  1 , Theofanis Korovesis  1 , Antonios Karanasos  1 , Sotirios Tsalamandris  3 , George Latsios  1 , Andreas Synetos  1 , Konstantinos Tsioufis  1 , Konstantinos Toutouzas  1
Affiliations
Review

Transcatheter Aortic Valve Implantation Access Sites: Same Goals, Distinct Aspects, Various Merits and Demerits

Odysseas Katsaros et al. J Cardiovasc Dev Dis. .

Abstract

Transcatheter aortic valve implantation (TAVI) has been established as a safe and efficacious treatment for patients with severe symptomatic aortic stenosis (AS). Despite being initially developed and indicated for high-surgical-risk patients, it is now offered to low-risk populations based on the results of large randomized controlled trials. The most common access sites in the vast majority of patients undergoing TAVI are the common femoral arteries; however, 10-20% of the patients treated with TAVI require an alternative access route, mainly due to peripheral atherosclerotic disease or complex anatomy. Hence, to achieve successful delivery and implantation of the valve, several arterial approaches have been studied, including transcarotid (TCr), axillary/subclavian (A/Sc), transapical (TAp), transaortic (TAo), suprasternal-brachiocephalic (S-B), and transcaval (TCv). This review aims to concisely summarize the most recent literature data and current guidelines as well as evaluate the various access routes for TAVI, focusing on the indications, the various special patient groups, and the advantages and disadvantages of each technique, as well as their adverse events.

Keywords: TAVI; TAVR; access site; aortic stenosis; axillary/subclavian; suprasternal-brachiocephalic; transaortic; transapical; transcarotid; transcaval.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Transfemoral transcatheter aortic valve implantation (TAVI) access rates in different registries. TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
(A) The main transcatheter aortic valve implantation (TAVI) access sites. (B) Factors for deciding the appropriate vascular access for TAVI. TAVI, transcatheter aortic valve implantation; LIMA, left internal mammary artery.
Figure 2
Figure 2
(A) The main transcatheter aortic valve implantation (TAVI) access sites. (B) Factors for deciding the appropriate vascular access for TAVI. TAVI, transcatheter aortic valve implantation; LIMA, left internal mammary artery.
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