Comparing traditional aortic valve surgery and transapical approach to transcatheter aortic valve implant

European Heart Journal Supplements : Journal of the European Society of Cardiology
Nicola BuzzattiOttavio Alfieri

Abstract

During the last 15 years, transcatheter aortic valve implant (TAVI) has become a valid alternative to surgical aortic valve replacement in symptomatic patients with severe aortic stenosis, and high or intermediate operative risk. Transcatheter aortic valve implant could be approached through various access sites, among which the transapical has long been one of the most popular. Through the years, this procedure has shown results similar to the standard surgical approach, but not as good as the same procedure via the transfemoral approach. For this reason, along with continuous technological advances, the transfemoral approach is used, presently, in 90% of the patient, while the transapical route has been limited, progressively, to a minority of patients. Currently the Heart Team should decide, in every single patient, between conventional surgery and TAVI. In clinical practice, TAVI is favoured in high-risk patients, and in the elderly at intermediate surgical risk with favourable anatomical features. In patients in whom TAVI is preferable to surgery, but have 'non-usable' femoral approach, alternative routes, such as transaxillary or transapical, could be considered.

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Citations

Aug 28, 2020·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Michael MorcosAndrew Remppis
Apr 15, 2021·The Thoracic and Cardiovascular Surgeon·Dritan UseiniJustus Strauch
Aug 31, 2021·Journal of Cardiac Surgery·Michele Di MauroRoberto Lorusso

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