Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement

Improvements in catheter technology make the transfemoral approach for transcatheter aortic valve replacement (TAVR) possible in approximately 95% of patients. Whilst alternative access is required in only a small proportion of patients, the rapid increase in the numbers of TAVR performed worldwide makes these approaches more frequent. Transthoracic approaches have been the traditional alternative to transfemoral access for TAVR; more recently, other approaches have been sought in an effort to reduce the excess rates of complications and mortality associated with transthoracic access. Herein, we review contemporary alternatives to transfemoral access for TAVR, including transaxillary/subclavian, transcarotid, and transcaval approaches.