Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation.
Rushmi PurmessurZeba AhmedJason M AliPublished in: Journal of clinical medicine (2024)
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80-90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations.
Keyphrases
- transcatheter aortic valve implantation
- aortic stenosis
- aortic valve replacement
- ejection fraction
- aortic valve
- transcatheter aortic valve replacement
- left ventricular
- minimally invasive
- end stage renal disease
- newly diagnosed
- coronary artery disease
- early onset
- clinical trial
- heart failure
- radiation therapy
- mitral valve
- atrial fibrillation
- patient reported