Author + information
- Received December 31, 2012
- Revision received March 29, 2013
- Accepted April 11, 2013
- Published online July 1, 2013.
- Stefan Toggweiler, MD∗,†,
- Jonathon Leipsic, MD∗,
- Ronald K. Binder, MD∗,
- Melanie Freeman, MBBS∗,
- Marco Barbanti, MD∗,
- Robin H. Heijmen, MD, PhD‡,
- David A. Wood, MD∗ and
- John G. Webb, MD∗∗ ()
- ∗Departments of Cardiology and Radiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- †Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
- ‡Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. John G. Webb, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z1Y6, Canada.
Transcatheter aortic valve implantation (TAVI) has emerged as a new therapy for patients with severe aortic stenosis who are inoperable or at very high risk of open heart surgery. Vascular complications are a potential limitation of TAVI and have been associated with bleeding, transfusions, and mortality. Transfemoral TAVI can be considered the least invasive approach and is therefore the most widely used access for TAVI. With the current 18-F to 24-F sheaths, the majority of patients can be treated via the transfemoral route. Initially, open surgical access was routinely used to introduce the large sheaths and catheters. Subsequently, percutaneous techniques have emerged as the new standard, resulting in a less invasive, fully percutaneous procedure. Stiff wires allow insertion of the sheath and delivery of the device without causing trauma to the artery. Given the high burden of vascular disease in TAVI candidates, increasing the effectiveness of pre-procedural screening is key. This often begins with conventional angiography, but computed tomography allows visualization of the artery in 3 dimensions, thereby overcoming some of the limitations of conventional angiography. Approximately one third of patients do not have adequate anatomy to allow safe transfemoral access. In such patients, alternative access routes such as the transapical, transaxillary, or direct aortic access are preferred. These alternative routes all have specific advantages and disadvantages.
- aortic stenosis
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
- vascular complications
Drs. Toggweiler and Binder are supported by a grant of the Swiss National Foundation. Drs. Binder, Leipsic, and Webb are consultants for Edwards Lifesciences. Dr. Heijmen is a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 31, 2012.
- Revision received March 29, 2013.
- Accepted April 11, 2013.