Swiss Cardiovascular Centre, Department of Cardiology, University Hospital, Bern, Switzerland.
EuroIntervention. 2013 Sep 10;9 Suppl:S14-8. doi: 10.4244/EIJV9SSA4.
Transcatheter aortic valve implantation (TAVI) is a widely accepted alternative to surgical aortic valve replacement (SAVR) among non-operable patients or selected high-risk patients with degenerative, severe aortic stenosis. TAVI is considered less invasive when compared with SAVR; however, there remain significant differences between different TAVI access routes. The transfemoral approach is considered the least invasive access route, and can be performed as a fully percutaneous procedure in a spontaneously breathing patient under local anaesthesia and mild sedation only. Moreover, transfemoral TAVI patients are typically transferred to coronary care rather than to an intensive care unit after the procedure, and benefit from early ambulation and a reduction in overall length of hospital stay. Considering these patient-specific and health-economic advantages, several TAVI centres follow the least invasive strategy for their patients and have implemented the transfemoral access route as the default access in their institutions. This article provides an overview on the prerequisites for a successful transfemoral TAVI procedure, describes the procedural advantages compared to alternative access routes, and highlights differences in clinical outcomes.
经导管主动脉瓣植入术(TAVI)是一种广泛接受的非手术或选择高危退行性重度主动脉瓣狭窄患者的外科主动脉瓣置换术(SAVR)替代方法。与 SAVR 相比,TAVI 被认为是一种微创方法;然而,不同的 TAVI 入路之间仍存在显著差异。经股动脉入路被认为是最微创的入路,可以在局部麻醉和轻度镇静下仅对自主呼吸的患者进行完全经皮操作。此外,经股动脉 TAVI 患者在手术后通常转移到冠心病监护病房而不是重症监护病房,并且受益于早期活动和总住院时间的缩短。考虑到这些患者特定和健康经济学的优势,一些 TAVI 中心为患者遵循最微创的策略,并在机构中实施经股动脉入路作为默认入路。本文概述了成功经股动脉 TAVI 手术的先决条件,描述了与替代入路相比的手术优势,并强调了临床结果的差异。