Description and Evolution of Alternative Access Route Options for Transcatheter Aortic Valve Implantation
Article Sidebar
Main Article Content
Abstract
This review describes the most common alternative access routes (i.e., direct aortic, transapical, transcarotid, transcaval, and transaxillary implantation techniques), their limitations, ergonomics, procedural results, and future perspectives in comparison to transfemoral (TF) transcatheter aortic valve implantation (TAVI).
Downloads
Article Details
Copyright (c) 2026 Schäfer U, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Praz F, Borger MA, Lanz J, Marin-Cuartas M, Abreu A, Adamo M, et al. 2025 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2025;46(44):4635-4736. Available from: https://doi.org/10.1093/eurheartj/ehaf194
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. Available from: https://doi.org/10.1093/eurheartj/ehab395
Sohal S, Mehta H, Kurpad K, Mathai SV, Tayal R, Visveswaran GK, et al. Declining trend of transapical access for transcatheter aortic valve replacement in patients with aortic stenosis. J Interv Cardiol. 2022:1-6. Available from: https://doi.org/10.1155/2022/5688026
Smith CR, Leon MB, Mack MJ, Miller C, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187-2198. Available from: https://doi.org/10.1056/nejmoa1103510
Lanz J, Greenbaum A, Pilgrim T, Tarantini G, Windecker S. Current state of alternative access for transcatheter aortic valve implantation. EuroIntervention. 2018;14:AB40-AB52. Available from: https://doi.org/10.4244/eij-d-18-00552
Eng MH, Qintar M, Apostolou D, O’Neill WW. Alternative access for transcatheter aortic valve replacement: a comprehensive review. Interv Cardiol Clin. 2021;10(4):505-517. Available from: https://doi.org/10.1016/j.iccl.2021.06.001
Morello A, Corcione N, Ferraro P, Cimmino M, Pepe M, Cassese M, et al. The best way to transcatheter aortic valve implantation: from standard to new approaches. Int J Cardiol. 2021;322:86-94. Available from: https://doi.org/10.1016/j.ijcard.2020.08.036
Banks A, Gaca J, Kiefer T. Review of alternative access in transcatheter aortic valve replacement. Cardiovasc Diagn Ther. 2020;10(1):72-82. Available from: https://doi.org/10.21037/cdt.2019.10.01
Young MN, Singh V, Sakhuja R. A review of alternative access for transcatheter aortic valve replacement. Curr Treat Options Cardiovasc Med. 2018;20(7):62. Available from: https://doi.org/10.1007/s11936-018-0648-5
Petronio AS, De Carlo M, Bedogni F, Maisano F, Ettori F, Klugmann S, et al. 2-year results of CoreValve implantation through the subclavian access: a propensity-matched comparison with the femoral access. J Am Coll Cardiol. 2012;60:502-507. Available from: https://doi.org/10.1016/j.jacc.2012.04.014
Schäfer U, Ho Y, Frerker C, Schewel D, Sanchez-Quintana D, Schofer J, et al. Direct percutaneous access technique for transaxillary transcatheter aortic valve implantation: “the Hamburg Sankt Georg approach.” JACC Cardiovasc Interv. 2012;5:477-486. Available from: https://doi.org/10.1016/j.jcin.2011.11.014
Schäfer U, Deuschl F, Schofer N, Frerker C, Schmidt T, Kuck KH, et al. Safety and efficacy of the percutaneous transaxillary access for transcatheter aortic valve implantation using various transcatheter heart valves in 100 consecutive patients. Int J Cardiol. 2017;232:247-254. Available from: https://doi.org/10.1016/j.ijcard.2017.01.010
Mylotte D, Sudre A, Teiger E, Obadia JF, Lee M, Spence M, et al. Transcarotid transcatheter aortic valve replacement: feasibility and safety. JACC Cardiovasc Interv. 2016;9(5):472-480. Available from: https://doi.org/10.1016/j.jcin.2015.11.045
Greenbaum AB, Babaliaros VC, Chen MY, Stine AM, Rogers T, O’Neill WW, et al. Transcatheter access and closure for transcatheter aortic valve replacement: a prospective investigation. J Am Coll Cardiol. 2017;69(5):511-521. Available from: https://doi.org/10.1016/j.jacc.2016.10.024
Greenbaum AB, O’Neill WW, Paone G, Guerrero ME, Wyman JF, Cooper RL, et al. Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients: initial human experience. J Am Coll Cardiol. 2014;63(25 Pt A):2795-2804. Available from: https://doi.org/10.1016/j.jacc.2014.04.015
Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, et al. Transcatheter aortic valve replacement using transaortic access: experience from the multicenter, multinational, prospective ROUTE registry. JACC Cardiovasc Interv. 2016;9(17):1815-1822. Available from: https://doi.org/10.1016/j.jcin.2016.06.031
Thourani VH, Jensen HA, Babaliaros V, Suri R, Vemulapalli S, Dai D, et al. Transapical and transaortic transcatheter aortic valve replacement in the United States. Ann Thorac Surg. 2015;100(5):1718-1726. Available from: https://doi.org/10.1016/j.athoracsur.2015.05.010