Suprasternal Access for Transcatheter Aortic Valve Replacement

Approximately 5% of patients undergoing transcatheter aortic valve replacement (TAVR) are not candidates for transfemoral (TF) access and existing alternative access strategies are imperfect. Suprasternal access is an alternative access technique where the innominate artery is cannulated from a small incision above the sternal notch. This technique provides excellent visualization of the innominate artery and the transcatheter valve can be aligned coaxially with the native aortic valve with minimal catheter angulation. Clinical outcomes with suprasternal TAVR have proven comparable to traditional TF TAVR, yet there are no head-to-head studies comparing different alternative access platforms against suprasternal access. Herein, we provide a visual review of the surgical technique and procedural steps, followed by a brief discussion of pre-procedural planning and the existing clinical data regarding this alternative access strategy.