Transcatheter aortic valve replacement (TAVR) by transfemoral access has shown great benefit for different risk groups, but its long-term durability is still uncertain. Available evidence comes from small analysis and a single randomized trial with 280 patients and an 8 year follow-up: the NOTION Trial, where TAVR showed less valvular degeneration than aortic valve replacement (AVR) surgery.…
TAVR: If Not Transfemoral, We Should Consider Transcaval Access
Transcatheter aortic valve replacement (TAVR) through transfemoral access has already proven its great benefits, but this access cannot be used in certain patients, and alternative accesses need to be considered for such cases. One of the most commonly used accesses is the transaxillary or transubclavian access (AX), which, however, is associated with more complications (especially…
Fluoroscopy vs. Ultrasound Guided Femoral Access in TAVR
Ideally, we will not puncture the femoral artery blindly if we are planning to use a big caliber releasing device and a percutaneous closure device during TAVR. The risk of a high or low puncture or the presence of a lateral branch compromising the puncture site might become a major vascular and bleeding complication. There…
MATRIX: Impact of Crossover from Radial Access to Femoral Access
The new MATRIX trial, recently published in JACC Interv., shows that an access-site crossover from radial to femoral access in patients with acute coronary syndrome cancels out the benefit provided by radial access as regards bleeding. However, there are no signs of comparative damage between successfully conducted radial or femoral access as a first attempt. …
TAVR: Should Transradial Approach be the Second Access Site?
Courtesy of Dr. Carlos Fava. One of the major challenges we interventional cardiologists still face is access management. Reduced device diameter and improved transcatheter closure, together with increased operator experience, have significantly reduced vascular complications. However, we shouldn’t lose sight of the secondary access, usually transfemoral, generally used in case of primary access site related…
Subclavian and Axillary Access for TAVR: a Valid Alternative
Courtesy of Dr. Carlos Fava. The femoral approach is preferred when it comes to TAVR, but sometimes it is not viable. This is when other access sites come into play, such as the trans-subclavian/axillary (TS/TAx), the apical, transcaval, transcarotid (TC) or transaortic. At present, few studies have looked into this matter, which is why it…
Transcaval Access Is Safe in TAVR
Courtesy of Dr. Carlos Fava. One of the limitations to percutaneous interventions is poor or impossible femoral access. This happens especially in TAVR, with endoprosthesis or ventricular assistance devices, when the transcaval approach with cardiac occluder rises as a viable alternative. We have started to use it in TAVR, but at present there is little…
Transcarotid Approach for Transfemoral in TAVR
Courtesy of Dr. Carlos Fava. At present, the transfemoral is the preferred access site in TAVR, for it has been shown to present fewer complications. However, whenever not feasible, we can resort to other approaches. These include the subclavian, the transapical, the transcaval, the transaortic, and the transcarotid. This last one has been studied few…
CTO: in Radial Access with Similar Results to Femoral
Courtesy of Dr. Carlos Fava. One of the characteristics of chronic total occlusion (CTO) is the use of two access routes: femoral and radial. The radial approach is safer, but it has not been thoroughly analyzed in this type of PCI. The study looked at 3709 patients undergoing left main percutaneous coronary intervention (PCI) for…
The transradial approach reduces the risk of kidney injury in acute patients
It remains unclear whether transradial access, compared with transfemoral access, presents a different risk of post-procedural kidney injury for patients admitted with acute coronary syndrome. Historically, it has been considered (without any evidence) that, given the higher difficulty associated with transradial access, it would require longer fluoroscopy time and higher contrast volume, which would eventually…
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