Chidester Jeffrey, Donisan Teodora, Desai Parth V, Banthiya Sukriti, Zaghloul Ahmed, Jessen Michael E, Park Ki, Tan Weiyi, Tsai Shirling, Huffman Lynn, Bavry Anthony A, Kumbhani Dharam J, Goyal Amit
Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22903, USA.
Mayo Clinic, Rochester, MN 55905, USA.
J Clin Med. 2025 Feb 28;14(5):1651. doi: 10.3390/jcm14051651.
Transcatheter aortic valve replacement (TAVR) was introduced in 2002 and has become integral in the management of aortic stenosis. As an alternative to surgical aortic valve replacement, it relies heavily on safe access to the aortic annulus for implantation of a valve prosthesis. Throughout its development and in current practice, the transfemoral (TF) arterial route for retrograde valve delivery has been the primary approach. However, this route is not appropriate for all patients, which has led to the development of multiple alternate access options. This review discusses the development of access for TAVR, followed by a thorough discussion of TF access. The commercially available products, preprocedural planning, closure techniques, and procedural complications are all discussed. We also describe the various alternate access routes with particular emphasis on the most recently developed route, transcaval access (TCv), with focus on procedural indications, technical considerations, and comparative outcomes. As TAVR technology, indications, and availability all expand, the knowledge and implementation of safe access are of utmost importance.
经导管主动脉瓣置换术（TAVR）于2002年引入，已成为主动脉瓣狭窄治疗中不可或缺的一部分。作为外科主动脉瓣置换术的替代方法，它在很大程度上依赖于安全进入主动脉瓣环以植入瓣膜假体。在其发展过程以及当前实践中，经股动脉（TF）逆行瓣膜输送途径一直是主要方法。然而，该途径并不适用于所有患者，这导致了多种替代入路的发展。本综述讨论了TAVR入路的发展，随后对TF入路进行了深入讨论。还讨论了市售产品、术前规划、闭合技术和手术并发症。我们还描述了各种替代入路，特别强调了最新开发的入路——经腔静脉入路（TCv），重点介绍了手术适应症、技术考虑因素和比较结果。随着TAVR技术、适应症和可及性的不断扩展，安全入路的知识和应用至关重要。
