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Page 2 of 11 Depboylu et al. Vessel Plus 2018;2:26 I http://dx.doi.org/10.20517/2574-1209.2018.39

Access sites and approaches for TAVR
Access site Approachs

1- Trans-femoral access Retrograde

2- Trans-subclavian access Retrograde
3- Direct aortic access Retrograde

4- Trans-carotid access Retrograde

5- Trans-apical access Antegrade

Figure 1. Access sites and approaches for transcatheter aortic valve replacement

Although its efficacy has been proven in patients with aortic valve stenosis having high surgical risks, as a
less invasive catheterization procedure, it has varying types of complications that may increase morbidity,
require urgent surgical intervention and even cause death. These complications can occur anytime during
and/or after the procedure, and include cerebrovascular events, vascular complications, bleeding, coronary
obstruction, myocardial infarction, valve regurgitation, valve malpositioning or migration, conduction dis-
turbances and acute kidney injury. With the advances in medical equipment and systems, improvements in
procedural techniques together with increasing experience and advances in patients’ imaging, these proce-
dural complications decreased dramatically. However, if occur, complications still remain the major factors
affecting the success of the procedure. To prevent and/or overcome these complications, all TAVR patients
should be evaluated by the “heart team” which consists of cardiologists, cardiac surgeons, radiologists and
anesthesiologists in equal proportion. The risks and/or difficulties of anesthesia and SAVR procedure should
be put forth by the cardiac surgeons and anesthesiologists, and declared to the patient. Once the decision of
performing TAVR procedure has been taken, structures and calcification loads of the aortic valve, aortic an-
nulus, aorta and access vessels should be evaluated by cardiologists, cardiac surgeons and radiologists via CT
images, angiogram and echocardiographic findings. The TAVR valve planned to be used, potential difficul-
ties of the procedure and possible complications should be determined and in case of complications, rescue
attempts should be planned before the procedure by the “heart team”. The procedure should be performed in
a hybrid operating room and surgical backup should be available whenever needed.

However, in all centers where TAVR is performed, it seems that a heart team with equal participation of spe-
cialists is not established and managed. Performing the procedure under this inappropriate condition may
cause doctors to inform the procedure as a risk-free intervention to the patients, to get out of the TAVR indi-
cations such as performing the procedure according to the patient’s wish only and to be caught unprepared
against the complications.

Here, for highlighting pre-procedural evaluation of the patients and being prepared against the complica-
tions of TAVR, we reviewed the possible complications of the TAVR procedure and described rescue proce-
dures and/or treatment options in case of complications, in the context of the literature.

VASCULAR COMPLICATIONS
The vascular complications of TAVR may be evaluated under two subheadings.

Minor/major vascular complications
Minor Vascular Complications
[3]
Vascular access injuries, those do not cause tissue malperfusion and do not require surgery .