title: Which way in? The necessity of multiple approaches to transcatheter valve therapy.
abstract: TAVI (transcatheter aortic valve implantation) is a less invasive treatment of the stenotic aortic valve while avoiding midline sternotomy and cardiopulmonary bypass. A crimped biological valve on a self-expanding or balloonexpandable stent is inserted antegradely or retrogradely under fluoroscopy, and deployed on the beating heart. Among the worldwide TAVI programs, many different concepts have been established for the choice of the access site. Whether retrograde or antegrade TAVI should be considered the superior approach is matter of an ongoing debate. The published literature demonstrates safety of all techniques if performed within a dedicated multidisciplinary team. Since there is no data providing evidence if one approach is superior to another, we conclude that an individualized patient-centered decision making process is most beneficial, taking advantage of the complementarity of the different access options. The aim of this article is to give an overview of the current practice of access techniques for transcatheter based valve treatment and to outline the respective special characteristics.
authors: S
authors: S
authors: Bleiziffer
authors: M
authors: M
authors: Krane
authors: M A
authors: MA
authors: Deutsch
authors: Y
authors: Y
authors: Elhmidi
authors: N
authors: N
authors: Piazza
authors: B
authors: B
authors: Voss
authors: Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstr. 36, 80636 Munich, Germany. bleiziffer@dhm.mhn.de.
authors: R
authors: R
authors: Lange
mesh_terms: D001011:Aorta; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005263:Femoral Artery; D005268:Femoral Vein; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins; D011859:Radiography; D013348:Subclavian Artery; D016896:Treatment Outcome