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Review
. 2021 Nov 29:15:e25.
doi: 10.15420/usc.2021.16. eCollection 2021.

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Eden C Payabyab  1 , Lindsay S Elbaum  2 , Navneet Sharma  2 , Isaac George  3 , Stephanie L Mick  1
Affiliations
Review

Shockwave and Non-transfemoral Transcatheter Aortic Valve Replacement

Eden C Payabyab et al. US Cardiol. .

Abstract

Transcatheter aortic valve replacement (TAVR) has become a widely adopted treatment modality for severe aortic stenosis. Transfemoral access is the approach of choice; however, approximately 25% of patients undergoing TAVR also have concomitant peripheral arterial disease. The recent advent of intravascular lithotripsy has enabled preservation of transfemoral access in some patients; although, a proportion still require alternative, non-femoral access. Alternative access sites can be broadly categorized into transthoracic and peripheral, facilitated by surgical or percutaneous techniques. In this review, the technical details and clinical outcomes of various TAVR accesses are discussed. Initially, transthoracic approaches were most common, but recently, the trend has been toward alternative peripheral access due to superior outcomes. Although there are no randomized data to support all the alternative access sites, the experiences reported provide available options for a large portion of patients to be candidates for TAVR. The intervention site should be selected by a multidisciplinary heart team based on patient anatomical factors and institutional expertise.

Keywords: Shockwave; Transcatheter aortic valve replacement; alternative access; transaxillary; transcarotid; transcaval; transthoracic.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Alternative Access Transcatheter Aortic Valve Replacement Sites
See this image and copyright information in PMC

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