Transaortic Transcatheter Aortic Valve Implantation: A Novel Approach for the Truly "No-Access Option" Patients

Objectives: The aim of this study was to test the safety and efficacy of the retrograde, minimally invasive, "transaortic" approach of transcatheter aortic valve implantation (TAVI) using the Medtronic Core Valve prosthesis (Medtronic, Minneapolis) as an alternative minimally invasive surgical access route. Background: TAVI is today recognized as an established percutaneous technique for patients with severe aortic valve stenosis (AS). However, as the number of patients screened for TAVI increases, many are found with absolutely no option for peripheral artery access. Methods: A new method of TAVI access, described as "transaortic" was performed in two patients A Core Valve prosthesis was implanted via the "transaortic" route. The patients were a 93- and a 84-year-old woman, both with severe PAOD. After a ministemotomy the ascending aorta was directly punctured. At the end, the access site was surgically sutured with the prepositioned sutures. The patients were at all times "off-pump" (beating heart procedure) and without IABP. Results: TAVI was successful in both cases, leading to a fall in the transvalvular gradient and there were no cases of mortality, stroke or myocardial infarction. The patients were extubated directly after the procedure, mobilized after 4 days, and were discharged home after 7 and 9 days. Conclusions: In the rare occasion, where due to anatomical reasons transfemoral TAVI is not feasible, a minimally invasive "transaortic" approach, as described, provides an alternative option. This is especially true when the transapical route is not suitable (annulus >25 mm or contraindication to lateral thoracotomy). (C) 2010 Wiley-Liss, Inc.