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Review
. 2025 Oct 13;18(19):2309-2325.
doi: 10.1016/j.jcin.2025.08.029.

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

Hans-Josef Feistritzer  1 , Oliver Dumpies  1 , Liesbeth Rosseel  2 , Darren Mylotte  3 , Toby Rogers  4 , Daniel J Blackman  5 , Fadi Sawaya  6 , Thomas Modine  7 , Tullio Palmerini  8 , Holger Thiele  1 , Axel Unbehaun  9 , Kendra J Grubb  10 , Ole de Backer  11 , Mohamed Abdel-Wahab  12
Affiliations
Free article
Review

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

Hans-Josef Feistritzer et al. JACC Cardiovasc Interv. .
Free article

Abstract

Current guideline recommendations for transcatheter aortic valve replacement are largely confined to procedures performed via transfemoral (TF) access. Major advances in preprocedural planning, delivery system technology, and procedural technique have led to substantial growth in TF access, even in complex vascular anatomies. However, determining the threshold beyond which TF access is either not feasible or carries unacceptable risk remains controversial. Furthermore, although alternative transvascular access routes have largely replaced surgical transthoracic approaches in patients unsuitable for TF access, the optimal alternative access route is still debated. Herein, the authors provide a state-of-the-art review of alternative access for TAVR, including the decision-making process between TF and non-TF approaches and the key elements of alternative access site selection and execution.

Keywords: TAVR; alternative access; transaxillary; transcarotid; transcaval; transthoracic.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Mylotte is a consultant for Medtronic, Microport, and Boston Scientific. Dr Rogers is a consultant for Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Laboratories, Anteris, and Transmural Systems; is an advisory board member for Medtronic and Boston Scientific; has equity interest in Transmural Systems; and is a coinventor on patents, assigned to the National Institutes of Health, for transcatheter electrosurgery devices. Dr Blackman has received honoraria from Abbott Vascular, Edwards Lifesciences, JenaValve Technologies, and Medtronic, and an institutional research grant from Medtronic. Dr Unbehaun serves as a physician proctor for Edwards Lifesciences, Medtronic, and JenaValve. Dr Grubb has received consulting fees or honoraria from Medtronic, Abbott Laboratories, Ancora, and 4C Medical; and has been a Medtronic employee. Dr Abdel-Wahab’s hospital receives consulting fees and/or speaking honoraria on his behalf from Medtronic, Boston Scientific, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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