INVASIVE INTERVENTIONS IN STRUCTURAL HEART DISEASES: COMPREHENSIVE TECHNIQUES

Invasive Interventions in Structural Heart Diseases-kapak

TRANSCATHETER AORTIC VALVE IMPLANTATION ALTERNATE ACCESS SITES

Kamuran Kalkan1
Burak Kardeşler2

1Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Cardiology, Ankara, Türkiye
2Ankara Bilkent City Hospital, Department of Cardiology, Ankara, Türkiye

Kalkan K, Kardeşler B. Transcatheter Aortic Valve Implantation Alternate Access Sites. Tanık VO, Özlek B editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.259-167.

ABSTRACT

Transcatheter aortic valve implantation (TAVI) has emerged as a trustworthy alternate to surgical aortic valve replacement (SAVR) due to recent technological advancements. Initially recommended for inoperable individuals with critical aortic stenosis, TAVI is now the primary option for risky patients and an substitute for moderate and low-risk groups. The transfemoral (TF) approach ruins the favored entry path due to its minimally invasive nature and lower complication rates. However, in cases where the TF approach is unsuitable, alternative routes include transapical (TAp), transaortic (TAo), transsubclavian (TSc), transcarotid (TCr), transcaval (TCv), and suprasternal approaches.

Alternative access sites are typically used in patients with severe comorbidities. Intrathoracic options like TAp and TAo require general anesthesia, whereas extrathoracic routes such as TSc, TCr, and TCv are often less invasive. Each access route has specific advantages and risks, with the decision largely dependent on anatomical considerations, operator experience, and institutional expertise. Current guidelines emphasize that when the TF approach is not feasible, alternative options should be assessed, and surgical options may need reconsideration.

Keywords: Transcatheter aortic valve implantation; Aortic stenosis; Access routes

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