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.
