Alternate Access for TAVI: Stay Clear of the Chest

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 an...

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Bibliographic Details
Published inInterventional cardiology (London) Vol. 13; no. 3; pp. 145 - 150
Main Authors Overtchouk, Pavel, Modine, Thomas
Format Journal Article
LanguageEnglish
Published England Radcliffe Cardiology 01.09.2018
Subjects
Structural
alternative approach
trans-subclavian
transcaval
TAVI
Alternative access
transaortic
TAVR
transapical
transcarotid
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ISSN1756-1477
1756-1477
1756-1485
DOI10.15420/icr.2018.22.1

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Summary: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.
Bibliography: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.
ISSN:1756-1477
1756-1477
1756-1485
DOI:10.15420/icr.2018.22.1