Conversations in IC: SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement-Manuscript - SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement

Manuscript - SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement

Pdf Summary

The "SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement" provides comprehensive guidelines for performing Transcatheter Aortic Valve Replacement (TAVR) via alternative access routes. TAVR is a primary treatment for symptomatic aortic stenosis usually performed via the transfemoral route; however, in around 4.7% of cases, alternative routes such as transaxillary, transcarotid, and transcaval must be used due to anatomical or clinical limitations.<br /><br />This statement outlines the factors affecting the choice of alternative access, emphasizing the advancements in device technology and imaging that have enhanced the safety and effectiveness of these procedures. It offers guidance on technical considerations and outcomes for each access route.<br /><br />The axillary/subclavian approach is noted for its ease of access and adequate arterial size for TAVR devices, although it carries a higher stroke risk. Transcaval access involves traversing the vein into the aorta, facilitating a less invasive yet complex procedure with a familiar operator setup. Meanwhile, transcarotid access benefits from simple surgical access without thoracic involvement, offering a straightforward procedure with a favorable risk profile.<br /><br />These routes are assessed in terms of morbidity, risk factors, and stroke rates, with transcaval and transcarotid methods preferred over transaxillary for their lower stroke risks and better discharge outcomes. Transfemoral access may be enhanced via intravascular lithotripsy and angioplasty in certain cases, although this requires further study to determine efficacy versus safety.<br /><br />The document stresses the importance of proctoring and training in alternative access techniques and highlights the need for further research and refinement in nonfemoral access strategies. It advocates for transcarotid and transcaval access as generally superior due to improved clinical outcomes compared to older methods like transapical and transaortic procedures. The statement serves as a critical guide for clinicians aiming to improve patient outcomes in complex TAVR cases.

Keywords

Transcatheter Aortic Valve Replacement

TAVR

aortic

TAVI

alternative access

transfemoral route

transaxillary

transcarotid

transcaval

aortic stenosis

device technology

clinical outcomes