Current guideline recommendations for transcatheter aortic valve replacement (TAVR) are largely confined to procedures performed via transfemoral (TF) access. Major advancements in pre-procedural planning, delivery system technology, and procedural technique have led to substantial growth in TF access, even in complex vascular anatomies. However, determining the threshold beyond which TF access is either not feasible or carries unacceptable risk remains controversial. Furthermore, while alternative transvascular access routes have largely replaced surgical transthoracic approaches in patients unsuitable for TF access, the optimal alternative access route is still debated. Herein, we provide a state-of-the-art review of alternative access for TAVR, including the decision-making process between transfemoral and non-transfemoral approaches, and the key elements of alternative access site selection and execution.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Hans-Josef Feistritzer, MD, PhD
Oliver Dumpies, MD
Mohamed Abdel-Wahab, MD
Important Dates
Date of Release: October 13, 2025
Term of Approval/Date of CME/MOC Expiration: October 12, 2026