Summary: Alternative Access Options for TAVR

Summary: Alternative Access Options for TAVR

February 25, 2025

Reference: SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement (JSCAI)

Key Points:

• Why Alternative Access?

• Transfemoral access is the preferred route for TAVR but is not always feasible due to patient anatomy or comorbidities.

• The Society for Cardiovascular Angiography & Interventions (SCAI) released expert recommendations for alternative access methods.

• Preferred Alternative Access Methods:

• Transcarotid and transcaval access are the best alternatives due to lower stroke risk and better patient outcomes.

• Transaxillary access is less favored.

• Transapical and direct aortic access are not recommended due to higher risks.

• Expert Insights:

• Dr. Matthew W. Sherwood:

• Despite device advancements, TAVR patients without femoral access need safe, standardized techniques.

• Alternative access options are especially important for older, high-risk patients with vascular disease.

• Dr. Paul D. Mahoney:

• TAVR is now a standard of care, and these guidelines help clinicians choose best practices for optimal patient outcomes.

• Looking Ahead:

• The consensus calls for further research into newer techniques like intravascular lithotripsy to refine TAVR access methods.

Conclusion:

These updated SCAI recommendations provide a structured approach for TAVR specialists, ensuring safer, more effective alternative access for patients who cannot undergo transfemoral TAVR.