Department of Cardiology, the Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310009.
Internal Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China, 310058.
J Cardiovasc Transl Res. 2024 Oct;17(5):973-989. doi: 10.1007/s12265-024-10484-z. Epub 2024 Aug 26.
For the past 20 years, transcatheter aortic valve replacement (TAVR) has been the treatment of choice for symptomatic aortic stenosis. The transfemoral (TF) access is considered the gold standard approach for TAVR. However, TF-TAVR cannot be performed in some patients; thus, alternative accesses are required. Our review paper generalises the TAVR accesses currently available, including the transapical, transaortic, trans-subclavian/axillary, transcarotid, transcaval, and suprasternal approaches. Their advantages and disadvantages have been analysed. Since there is no standard recommendation for an alternative approach, access selection depends on the expertise of the local cardiac team, patient characteristics, and access properties. Each TAVR centre is recommended to master a minimum of one non-TF access alternative. Of note, more evidence is required to delve into the clinical outcomes of each approach, at both early and long-term (Figure 1).
在过去的 20 年中，经导管主动脉瓣置换术（TAVR）已成为治疗有症状的主动脉瓣狭窄的首选方法。经股动脉（TF）入路被认为是 TAVR 的金标准方法。然而，TF-TAVR 不能用于某些患者；因此，需要替代入路。我们的综述文章概括了目前可用的 TAVR 入路，包括经心尖、经主动脉、经锁骨下/腋窝、经颈动脉、经腔静脉和胸骨上入路。分析了它们的优缺点。由于没有替代方法的标准建议，因此入路选择取决于当地心脏团队的专业知识、患者特征和入路特性。建议每个 TAVR 中心至少掌握一种非 TF 入路替代方法。值得注意的是，需要更多的证据来深入研究每种方法的早期和长期临床结果（图 1）。
