Damluji AA, et al. - In this observational study, researchers evaluated the outcomes of older adults undergoing nontrans-femoral (non-TF) transcatheter aortic valve replacement (TAVR) procedures including trans-apical (TA), trans-aortic (TAo), trans-subclavian (TSub), and trans-carotid (TCa) techniques for symptomatic severe AS at three centers in France and the United States from April 2008 to February 2017. There are regional differences when it comes to the choice of alternative access techniques, but safe alternatives to traditional TF TAVR are offered by centers with high technical expertise. Relative to other non-TF approaches, TAo TAVR was found to be related to higher in-hospital mortality, probably due to patient instead of procedural factors. One-year follow-up revealed similar mortality rates and clinical outcomes for all alternative access techniques. Results showed the safety and feasibility of trans-carotid access vs other non-TF access techniques.