EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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Transradial (TR) cardiac catheterisation is thought to be associated with an increased exposure to radiation compared with the traditional transfemoral (TF) access. This paper provides a review of current literature describing these reported associations. Although several studies have reported an increase in radiation exposure to both operator and patient with TR compared with TF access, others have reported findings suggesting no significant difference, even reporting decreased exposure with TR access. Ultimately, increased radiation exposure appears likely with TR access; however, in consideration of the many benefits associated with TR access, radiation exposure remains only one of many considerations when deciding between routes of access.
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Review Comparative Study
Subclavian TAVI: more than an alternative access route.
The standard approach for transcatheter aortic valve implantation (TAVI) is through the transfemoral retrograde route, because it is minimally invasive and it is feasible under conscious sedation in a totally percutaneous fashion. When the transfemoral access is not feasible, the most used approaches are the transapical for the balloon-expandable Edwards SAPIEN XT valve, the subclavian for the Medtronic self-expandable CoreValve and the transaortic for both prostheses. ⋯ Although no direct comparison between the subclavian, transaortic and transapical approaches is available, in our opinion the subclavian access should be favoured, because of its lower invasiveness and its feasibility without general anaesthesia. The choice of vascular access should be taken by the Heart Team and should remain patient-centred rather than operator-preference driven.