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  • Editorial: In the Garden of Forking Paths: Choosing Between Alternative Access for TAVR

    Transcatheter aortic valve replacement (TAVR) has exceeded surgical valve replacement in 2019, becoming the most common treatment strategy for severe symptomatic aortic stenosis  . However, surpassing surgical valve replacement was only one of several important trends observed in TAVR practice in the last decade. Increasing operator experience, reduction in procedural complications, shorter hospital stays, and reduction in short and long-term mortality have facilitated the gradual expansion of TAVR indication from extreme-to low-risk patients  . Moreover, owing to innovation in technology and the introduction of lower-profile sheaths, significant progress was similarly observed in TAVR access options, as femoral access became the strategy of choice: While 42% of patients underwent apical access in the PARTNER I  , it was used only in 8.2% of patients in PARTNER II  , broadly abandoned and replaced by the femoral access.

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