Which way in? The Necessity of Multiple Approaches to Transcatheter Valve Therapy
TAVI (transcatheter aortic valve implantation) is a less invasive treatment of the stenotic aortic valve while
avoiding midline sternotomy and cardiopulmonary bypass. A crimped biological valve on a self-expanding or balloonexpandable
stent is inserted antegradely or retrogradely under fluoroscopy, and deployed on the beating heart. Among the
worldwide TAVI programs, many different concepts have been established for the choice of the access site. Whether retrograde
or antegrade TAVI should be considered the superior approach is matter of an ongoing debate. The published literature
demonstrates safety of all techniques if performed within a dedicated multidisciplinary team. Since there is no data
providing evidence if one approach is superior to another, we conclude that an individualized patient-centered decision
making process is most beneficial, taking advantage of the complementarity of the different access options. The aim of
this article is to give an overview of the current practice of access techniques for transcatheter based valve treatment and
to outline the respective special characteristics.
Keywords: Transcatheter valve implantation, transapical, transfemoral, subclavian, transaortic.
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