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Review
. 2024 Aug 8;13(16):4655.
doi: 10.3390/jcm13164655.

Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation

Rushmi Purmessur  1 , Zeba Ahmed  2 , Jason Ali  1
Affiliations
Review

Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation

Rushmi Purmessur et al. J Clin Med. .

Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.

Keywords: surgical access; transaortic; transapical; transaxillary; transcarotid; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
a. Trans-carotid access. Incision along anterior border of sternocleidomastoid muscle. b. Transaortic access. Right anterior mini-thoracotomy in 2nd or 3rd intercostal space. c. Mini upper partial sternotomy to 2nd or 3rd intercostal space. d. Trans-subclavian/transaxillary access. Incision in the delto-pectoral groove. e. Transapical access. Left anterior mini-thoracotomy in infra-mammary fold or 4th or 5th intercostal space.
Figure 2
Figure 2
Trans-subclavian/subaxillary access.
Figure 3
Figure 3
Trans-carotid access.
Figure 4
Figure 4
Transaortic access.
Figure 5
Figure 5
Transapical access.
See this image and copyright information in PMC

References

    1. Andersen H.R., Knudsen L.L., Hasenkam J.M. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur. Heart J. 1992;13:704–708. doi: 10.1093/oxfordjournals.eurheartj.a060238. - DOI - PubMed
    1. Cribier A., Eltchaninoff H., Bash A., Borenstein N., Tron C., Bauer F., Derumeaux G., Anselme F., Laborde F., Leon M.B. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis. Circulation. 2002;106:3006–3008. doi: 10.1161/01.CIR.0000047200.36165.B8. - DOI - PubMed
    1. Cribier A., Eltchaninoff H., Tron C., Bauer F., Agatiello C., Sebagh L., Bash A., Nusimovici D., Litzler P., Bessou J.-P., et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. J. Am. Coll. Cardiol. 2004;43:698–703. doi: 10.1016/j.jacc.2003.11.026. - DOI - PubMed
    1. Webb J.G., Chandavimol M., Thompson C.R., Ricci D.R., Carere R.G., Munt B.I., Buller C.E., Pasupati S., Lichtenstein S. Percutaneous Aortic Valve Implantation Retrograde from the Femoral Artery. Circulation. 2006;113:842–850. doi: 10.1161/CIRCULATIONAHA.105.582882. - DOI - PubMed
    1. Stortecky S., O’Sullivan C.J., Lutz Buellesfeld Windecker S., Wenaweser P. Transcatheter aortic valve implantation: The transfemoral access route is the default access. EuroIntervention. 2013;9:S14–S18. doi: 10.4244/EIJV9SSA4. - DOI - PubMed

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