| Access |
Femoral artery |
Left ventricular apex |
| Access mode |
Retrograde |
Antegrade |
| Incision length [cm] |
1-2 |
~5 |
| Distance to aortic valve [cm] |
~70-100 |
~7-10 |
| Wire insertion |
Through the aortic arch, retrograde |
Through the aortic arch, antegrade |
| Wire positioning |
Arbitrary, across iliac vessels and aortic arch, irregularities, slack |
Coaxial, straight |
| Valve insertion |
Through the aortic arch, retrograde |
No touch aorta |
| Valve orientation |
Arbitrary |
Commissural (anatomical) alignment possible |
| Valve implantation |
Some mobility during implantation |
Little mobility, stepwise and controlled implantation usually feasible |
| Application system retrieval |
Across the aortic arch, relatively long distance |
Direct and straight |
| Access closure |
Complication rates as high as 10% |
Very low complication rate, ~1% |
| Perspectives |
Smaller systems will become available |
Allows access to almost any diameter of the devices – this may lead to potentially better tissue longevity |
| Future developments |
Improved vascular closure systems |
Percutaneous access and closure systems |
