Transcatheter Aortic Valve Replacement: Alternative Access beyond the Femoral Arterial Approach

Demetrios A. Raptis, Michael A. Beal, David C. Kraft, Hersh S. Maniar, Andrew J. Bierhals 

Author Affiliations

• From the Mallinckrodt Institute of Radiology (D.A.R., M.A.B., D.C.K., A.J.B.) and Department of Cardiothoracic Surgery (H.S.M.), Washington University School of Medicine, 216 S Kingshighway Blvd, St Louis, MO 63110.
• Address correspondence to A.J.B. (e-mail: bierhalsa@wustl.edu).

Published Online:Nov 23 2018https://doi.org/10.1148/rg.2019180059

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Abstract

This article highlights indications and contraindications of alternative access routes for transcatheter aortic valve replacement (TAVR) and the radiologist’s role in providing additional preprocedure images and measurements to help guide placement of the valve.

Aortic stenosis is the most prevalent valvular cardiovascular disease affecting the population over the age of 65 years. Transcatheter aortic valve replacement (TAVR) was developed as a minimally invasive surgical intervention to treat aortic stenosis in patients at high risk for surgical complications. Although the most commonly used approach for placement of a transcatheter aortic valve is in retrograde fashion via a transfemoral approach, narrowed luminal diameters, extensive atherosclerotic disease, or significant tortuosity may limit use of this route. In these patients, alternative methods including subclavian, transaortic, and transapical approaches should be considered. An understanding of these access routes and their respective indications and contraindications allows the radiologist to provide additional preprocedure measurements and images to help guide placement of the valve.