About this Research Topic

Background

Since its introduction in 2002, transcatheter aortic valve replacement (TAVR) has been a rapidly evolving therapy in structural heart interventions. The indication expanded from high- to intermediate-risk patients. Currently, TAVR is increasingly offered to low-risk patients. With the reduction of delivery sheath profiles and improvements of vascular closure devices, TAVR has become a predominantly fully percutaneous transfemoral procedure. Current generation transcatheter heart valve (THV) systems feature either low profile delivery catheters for sheathless THV implantation or expandable delivery sheaths aiming to lower the vascular trauma and improve access related vascular complication rates.

Even with the current generation of transcatheter heart valve delivery systems, vascular complications are still considerable risks in THV implantation that impair the recovery and patients' survival. To lower vascular complications, efforts are made to lower vascular trauma by reduction of delivery sheath profile or utilization of expandable delivery sheaths. Ultrasound-guided puncture or utilization of microneedles support precise vascular access. Moving on from established suture-based vascular closure devices (VCD), dedicated large bore VCD were also developed to improve the sealing of large bore puncture sites. Surgical cut-down is an alternative to offer safe access and closure to heavily calcified femoral vessels. Intravascular lithotripsy seems to offer transfemoral implantation even in calcified and small access vessels. Refinements of transaxillary, transapical, transaortic, transcarotid, transcaval and suprasternal access improve feasibility and safety of alternative access in non-transfemoral patients.

We encourage researchers to contribute to this research topic with submissions covering current strategies in vascular access and closure. We aim to analyze the underlying mechanisms of vascular complications and their clinical consequences. We encourage presenting clinical experiences with different vascular closure devices or surgical cut-down. We would like to cover the value of intravascular lithotripsy to enable transfemoral access in challenging anatomy. Finally, we ask for coverage of alternative access routes for TAVR in anatomies not eligible for transfemoral access.

Keywords: TAVR, vascular access, vascular complications, vascular closure devices, alternative access

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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