The Society for Cardiovascular Angiography & Interventions (SCAI) has released an expert consensus statement offering interventional cardiologists, cardiothoracic surgeons, and heart teams practical recommendations for selecting patients and performing alternative access transaortic valve replacement (TAVR).
Over the past decade, TAVR has grown significantly, becoming the standard of care for many patients with asymptomatic aortic stenosis. However, some patients face challenges due to limited femoral vascular access. The new guidelines address this issue by recommending alternative access methods that are both safer and more effective.
The guidelines focus on the safest and most effective alternative access methods backed by observational evidence. The guidelines are particularly beneficial for older, sicker patients with significant vascular disease, who are at higher risk of complications during TAVR procedures. By standardising alternative access techniques, the goal is to improve outcomes and expand treatment options for these patients.
Published in JSCAI, the “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 favoured over others, such as transaxillary access, due to their lower stroke risk and better overall outcomes. The guidelines advise against using older techniques like transapical or direct aortic access. The statement also emphasises the advancements in device technology and imaging guidance, which have enhanced the safety and efficacy of alternative access TAVR.
The goal of the updated guidelines is to support clinicians in providing better care for their patients by offering guidance on the safest and most effective routes for alternative access TAVR. This is particularly important as the TAVR population continues to grow. TAVR has evolved from a novel procedure to a standard of care. Therefore, it is important to identify best practices and achieve optimal outcomes for patients.
The guidelines call for greater standardisation and focus on alternative access techniques at individual sites, including the use of proctors to build expertise. They also stress the need for further research and standardisation, as more data is required to fully understand the risks and benefits of TAVR alternative access techniques. Additionally, the guidelines suggest exploring newer techniques, such as intravascular lithotripsy, to further improve patient outcomes.
Source: Society for Cardiovascular Angiography and Interventions
Image Credit: iStock
