Transcatheter aortic valve replacement (TAVR): access planning and strategies.
Transcatheter aortic valve replacement (TAVR) has proven to be a viable tool for the high-surgical-risk population with severe aortic valve stenosis. Vascular access complications are not uncommon with TAVR and may increase early and late mortality. Avoiding these serious complications is the goal. With experience and careful screening, we are now able to risk-stratify patients who may be at increased risk of vascular complications. While the traditional iliofemoral access site remains the most common for TAVR, alternate access sites that have proven to be viable and safe alternatives include the transapical, direct-aortic, and subclavian techniques. TAVR teams should be familiar and comfortable with these approaches as each of them has its own advantages and weaknesses. The best option is usually one in which the procedure is tailored to the patient. The present review examines our current access planning and strategies for TAVR.
Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, Texas, USA.
Basel
B
Ramlawi
Javier E
JE
Anaya-Ayala
Michael J
MJ
Reardon
D001011:Aorta; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D006328:Cardiac Catheterization / Q000379:methods*; D005263:Femoral Artery; D006330:Heart Defects, Congenital / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D006349:Heart Valve Diseases / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D018570:Risk Assessment; D013348:Subclavian Artery