Conclusion
According to our data, the TA and SC approaches were associated with almost similar long-term survival. Based on these findings, the key message of this study is that SC and TA are established, feasible and comparatively safe alternative strategies to the default retrograde femoral access for TAVI. However, in more recent years, there has been an increase in the use of the subclavian and axillary route, including percutaneous approaches performed under local anaesthetic, and a corresponding decline in TA access. As with any operative technique, the choice to select a specific approach is determined by different combinations of patients’ comorbidity, vascular characteristics, transcatheter aortic valve prosthesis, availability of new performing devices on the market, and skill, mastery, expertise, and experience of the entire Heart Team, who remains the key factor to lead to the best choice tailored for each single patient.