**8. Techniques**

The TAVR procedure is commonly performed in a hybrid room that has both Cath lab and operating room abilities, although some are performing the procedure in a standard cardiac catheterization laboratory. Primarily driven by visualization on fluoroscopy correlating to previously performed CT scan. At times, various Heart Teams will use transesophageal echocardiographic coregistration with fluoroscopy. There are various accesses used, with transfemoral arterial approach being the most common one. Approximately more than 95% of cases are completed this way. The femoral route has also shown lower rates of complications. However, when this method cannot be used due to severe tortuosity or diseased iliofemoral arterial vessels, an alternative route can be chosen based on the particular valve being used, patient's risk factors, or if a patient has unfavorable iliofemoral artery characteristics [44].

The alternative common access options include transubclavian access, transthoracic approach (transapical antegrade and transaortic retrograde), and transcarotid approach.



*† Data derived from TVT. Gary. UK TAVI. Observant and France2 registries.‡ Data derived from Partner A, Partner B, Partner II, Notion and SURTAVI trials.*

#### **Table 2.**

*Procedural outcomes per access site [46].*
