Different Sites of Vascular Access for Transcutaneous Aortic Valve Implantation (TAVI)

Abstract

Aortic valve stenosis is a common valvular heart disease and its incidence is increasing day by day as the life expectancy is increasing gradually. It can be of congenital or acquired variety but in old ages aortic stenosis is acquired mostly and main reasons rheumatic heart disease or senile calcification of aortic valve. Aortic valve replacement with mechanical tissue valves is the surgical management of aortic valve stenosis but some of the patients are not suitable for the surgery based on their physical status and associated comorbidities. These patients are high risk for surgical complications or they have prohibitive risks for surgery. Transcutaneous aortic valve implantation is the new technique developed to implanting aortic valve mostly without opening the sternum and without using cardiopulmonary bypass machine. This procedure is mostly done via transfemoral access but in case of contraindications to use femoral artery for access some other different accesses are used to implant the aortic valve, that is, transsubclavian/transaxillary access, transapical access, transaortic access, transcarotid and transcaval accesses. In this chapter we are going to discuss all accesses in details.