Do we need alternative access in TAVR anymore?

Transcatheter aortic valve replacement (TAVR) has expanded widely in recent years. The femoral access constitutes the gold standard and the first-line access for TAVR procedures1,2, allowing totally percutaneous procedures. Despite several iterations in device profiles and the improvement of TAVR techniques, 10 to 15% of patients are deemed ineligible for femoral access due to unfavourable femoral or aortic anatomy3. While the European guidelines4 recommend the surgical option in intermediate-risk patients if the femoral access is not feasible, non-femoral peripheral (nFP) accesses have emerged as alternatives to the femoral access, achieving comparable results in high-volume centres5,6 with a trend towards more minimalist ...