Transcatheter aortic valve implantation (TAVI) is performed through a retrograde transfemoral approach in approximately 80-90 % of cases thanks to the improvements in delivery catheter prole, size and steerability compared with the rst generation devices. The aim of this review article is to describe the challenges of transfemoral TAVI and the options to overcome them. The difculties may be related to the access itself or the placement of the valve using the transfemoral route. Comprehensive patient screening using multislice computed tomography and crossover techniques to prevent bleeding should result in low complication rates even for fully percutaneous procedures. Horizontal ascending aorta and severely calcied aortic valves remain a challenge for retrograde valve crossing, device advancement and accurate positioning during deployment. The buddy balloon technique is a simple option in the case of difcult aortic valve crossing with a delivery catheter, whereas an antegrade approach using the transapical route is a reasonable alternative in such anatomy.
Stephane Noble : Organization - Cardiology Division, University Hospital of Geneva, Geneva, Switzerland
Marco Roffi : Organization - Cardiology Division, University Hospital of Geneva, Geneva, Switzerland