Transaortic transcatheter aortic valve implantation using the Edwards Sapien valve

Transcatheter aortic valve implantation using Edwards Sapien Valve can be carried out through the ascending aorta. In the majority of patients, the ascending aorta is approached through a partial upper J-sternotomy. The sternotomy extends into the right second or third right intercostal space. The pericardium is opened in midline and the top of the ascending aorta is exposed. Two purse-string sutures are then placed on the ascending aorta and Sapien valve implantation is carried out using the Ascendra delivery system with the valve mounted in a reverse fashion to that of a transapical approach. Owing to the familiarity of the surgeons with exposing the aorta and placing purse-strings for cannulation, this procedure is within the comfort zone of surgeons compared with the transapical approach. Advantages, contra--indications, surgical technique and results are also discussed.