WASHINGTON—The Society for Cardiovascular Angiography & Interventions (SCAI) has published an expert consensus statement that provides interventional cardiologists, cardiothoracic surgeons, and heart teams with practical guidance for selecting patients and performing alternative access transaortic valve replacement (TAVR).
TAVR has seen substantial growth over the past decade, becoming a standard of care for many patients with asymptomatic aortic stenosis. However, some patients face challenges due to inadequate femoral vascular access. The new guidelines address this gap by recommending alternative access techniques that are safer and more effective.
"While devices have improved, there remains a need for robust techniques to provide TAVR to patients without adequate femoral access. Our guidelines focus on the safest and most effective alternative access methods based on observational evidence," said Matthew W. Sherwood, MD, MHS, FSCAI , cochair of SCAI's Structural Heart Disease Council and system director of interventional cardiology at Inova Schar Heart and Vascular Institute. "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."
Published in JSCAI, " SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement " highlights two preferred alternative access techniques: transcarotid and transcaval access. These methods are favored over others, such as transaxillary access, due to their lower associated stroke risk and better overall outcomes. The guidelines discourage the use of older techniques like transapical or direct aortic access. The document also highlights the advancements in device technology and imaging guidance that have contributed to improving the safety and efficacy of alternative access TAVR.
"With this expert consensus document, we aim to help clinicians better care for their patients by providing guidance on the safest and most efficacious routes for alternative access to TAVR. This is crucial as the TAVR population continues to grow," said Paul D. Mahoney, MD, FSCAI , a member of the SCAI Structural Heat Disease Council and Section Chief, Interventional Cardiology and Director of Structural Heart Programs, East Carolina University Brody School of Medicine. "TAVR as a field is maturing from a novel procedure to a standard of care. The goal is to help busy clinicians identify best clinical practices and achieve the best outcomes for their patients."
The guidelines call for better standardization and focus on alternative access techniques at individual sites, such as the use of proctors to gain expertise. The guidelines emphasize the need for further research and standardization, as more data is needed to fully understand the risks and benefits of TAVR alternative access techniques. The guidelines also call for the exploration of newer techniques, such as intravascular lithotripsy, to further improve patient outcomes.
"There is still a lot we don't know, and we want to ensure that we provide the best care for our patients by continuing to study and improve these techniques," Dr. Sherwood said.
About SCAI
The Society for Cardiovascular Angiography and Interventions is a professional organization representing more than 4,000 invasive and interventional cardiology professionals in approximately 75 nations. SCAI's mission is to promote excellence in invasive/interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care.
