Know your options: What cardiologists recommend when alternative access is required for TAVR

Transfemoral access is not always a viable option during transcatheter aortic valve replacement (TAVR) procedures. In those instances, the two most effective alternatives are transcarotid access and transcaval access, according to a new expert consensus statement from the Society for Cardiovascular Angiography & Interventions (SCAI).[1]

SCAI developed the recommendations to help cardiologists, cardiothoracic surgeons and other heart specialists adapt when TAVR patients present with anatomy or comorbidities that make transfemoral access especially challenging. The document, “SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement,” was published in full in JSCAI.

According to these new recommendations, transcarotid and transcaval access are preferred over transaxillary access and other potential options due to the lower stroke risk and improved patient outcomes. Transapical and direct aortic access, meanwhile, are not recommended for any patients. 

“While devices have improved, there remains a need for robust techniques to provide TAVR to patients without adequate femoral access,” Matthew W. Sherwood, MD, cochair of SCAI’s Structural Heart Disease Council and system director of interventional cardiology at Inova Schar Heart and Vascular Institute, said in a prepared statement. “Our guidelines focus on the safest and most effective alternative access methods based on observational evidence. The guidelines are particularly beneficial for older, sicker patients with significant vascular disease. These high-risk patients often face complications during TAVR procedures. By standardizing alternative access techniques, we aim to improve outcomes and expand treatment options for these patients.”