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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

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Transapical access for thoracic endograft delivery.

Tilo Kölbel¹, Hendrik Treede, Sebastian William Carpenter

¹Department of Vascular Medicine, University Heart Center, Hamburg, Germany. tilokoelbel@googlecom

|November 15, 2011

Summary

Transapical access for thoracic endograft deployment is feasible for complex aortic arch aneurysms. However, this technique, combined with debranching, carries a high risk of serious complications.

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Area of Science:

Cardiovascular Surgery
Vascular Surgery
Interventional Cardiology

Background:

Thoracic endografting is a minimally invasive option for aortic arch aneurysms.
Transapical access offers an alternative route for endograft delivery when traditional femoral access is not feasible.
Complex aortic pathologies may necessitate combined access strategies and extensive surgical preparation.

Observation:

A case study details the transapical deployment of a thoracic endograft in a 73-year-old patient with a large aortic arch aneurysm.
The patient had multiple comorbidities and was unsuitable for open surgical repair.
Femoral access was contraindicated due to extensive thoracoabdominal aneurysm and iliac artery calcification.

Findings:

A combined transapical and left subclavian approach with bilateral iliac-subclavian debranching successfully excluded the thoracic aortic aneurysm.
The patient experienced a fatal myocardial infarction within 24 hours postoperatively.
The study highlights the technical feasibility of transapical access for thoracic endografts.

Implications:

Transapical access is a viable option for thoracic endografting in highly selected patients with complex anatomy.
This approach, particularly when combined with extensive debranching, is associated with significant periprocedural risks.
Further research is needed to refine patient selection and optimize outcomes for this challenging procedure.