Horizontes expandidos en TAVI: explorando las rutas de acceso no transfemoral para cirujanos cardíacos

Abstract

Transcatheter aortic valve implantation (TAVI) has become the primary treatment for symptomatic severe aortic stenosis, particularly in patients over 75 years of age and those at high surgical risk. In the last two decades, the number of TAVI procedures has significantly increased, and this trend is expected to continue. Despite the preference for transfemoral access in TAVI, it is unsuitable for up to 20% of patients due to anatomical contraindications such as inadequate vessel size, heavily calcified iliofemoral vasculature, or extreme vessel tortuosity. This has led to the exploration and development of non-TF TAVI approaches, including intrathoracic and extrathoracic approaches.

The emergence of different access routes for TAVI has not been simultaneous, and the choice between intrathoracic and extrathoracic accesses is multifaceted, influenced by the patient's anatomy, comorbidities, and the expertise of the treating center. The transapical approach, classified as intrathoracic, has been the main non transfemoral alternative for nearly a decade. However, the emergence of extrathoracic accesses, such as the transcarotid and transsubclavian approaches, has broadened the horizons of TAVI, potentially offering better outcomes for specific patient populations.