SCAI Publishes Expert Consensus Statement on Alternative Access for TAVR

February 25, 2025—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the publication of an expert consensus statement on alternative access transcatheter aortic valve replacement (TAVR) procedures. The statement provides interventional cardiologists, cardiothoracic surgeons, and heart teams with practical guidance for selecting patients and performing alternative access TAVR, noted the society.

According to SCAI, the new guidelines address the gap between TAVR as a standard of care for many patients with asymptomatic aortic stenosis versus the challenges of TAVR for some patients with inadequate femoral vascular access. The statement recommends alternative access techniques that are safer and more effective.

SCAI advised that the consensus statement highlights transcarotid and transcaval access as two preferred alternative access techniques, noting that these are favored over other methods, such as transaxillary access, because of their lower associated stroke risk and better overall outcomes. Additionally, the publication discourages the use of older techniques like transapical or direct aortic access.

The guidelines also highlight advancements in device technology and imaging guidance that have contributed to improving the safety and efficacy of alternative access TAVR, stated the society.

As summarized in the SCAI press release, the guidelines call for the following:

• Better standardization and focus on alternative access techniques at individual sites, such as the use of proctors to gain expertise
• Further research and standardization because more data are needed to fully understand the risks and benefits of alternative access techniques for TAVR
• Exploration of newer techniques, such as intravascular lithotripsy, to further improve patient outcomes

“SCAI Expert Consensus Statement on Alternative Access for Transcatheter Aortic Valve Replacement” by Matthew Sherwood, MD, et al was published online in JSCAI. Dr. Sherwood is System Director of Interventional Cardiology at Inova Schar Heart and Vascular Institute in Woodburn, Virginia, and serves as Cochair of SCAI’s Structural Heart Disease Council.

“While devices have improved, there remains a need for robust techniques to provide TAVR to patients without adequate femoral access,” commented Dr. Sherwood in the SCAI press release. “Our guidelines focus on the safest and most effective alternative access methods based on observational evidence.”

Dr. Sherwood continued, “The guidelines are particularly beneficial for older, sicker patients with significant vascular disease. These high-risk patients often face complications during TAVR procedures. By standardizing alternative access techniques, we aim to improve outcomes and expand treatment options for these patients.”

He concluded, “There is still a lot we don’t know, and we want to ensure that we provide the best care for our patients by continuing to study and improve these techniques.”

Paul D. Mahoney, MD, a member of the SCAI Structural Heart Disease Council, added in the press release, “With this expert consensus document, we aim to help clinicians better care for their patients by providing guidance on the safest and most efficacious routes for alternative access to TAVR. This is crucial as the TAVR population continues to grow.”

Dr. Mahoney, Section Chief of Interventional Cardiology and Director of Structural Heart Programs at East Carolina University Brody School of Medicine in Greenville, North Carolina, further stated, “TAVR as a field is maturing from a novel procedure to a standard of care. The goal is to help busy clinicians identify best clinical practices and achieve the best outcomes for their patients.”