TAVI Access — RACP Adult Medicine MCQ

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HardCardiologyTAVI AccessRACP Adult Medicine

A 70-year-old man with severe aortic stenosis (AVA 0.7 cm²) who is deemed high surgical risk is considered for TAVI. His CT shows a porcelain (heavily calcified) aorta. He has no peripheral vascular disease. What is the preferred TAVI access route?

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Correct answer: A — Transfemoral

Transfemoral access is the preferred route for TAVI as it is the least invasive with the best outcomes. A porcelain aorta is actually an additional argument FOR transfemoral TAVI rather than surgical AVR (where aortic cross-clamping would be extremely hazardous with a porcelain aorta). If transfemoral access is not feasible (e.g., severe iliofemoral disease), alternative routes include subclavian, transaortic, or transapical.

Reference: CSANZ – 2022 – TAVI Guidelines; ESC – 2021 – Valvular Heart Disease