Related Experiment Video
Updated: Mar 18, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transaortic approach for transcatheter aortic valve replacement with other concomitant cardiac procedures in
Michal Hulman1, Martin Bena1, Panagiotis Artemiou1
1Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
Insights
The transaortic approach for transcatheter aortic valve replacement (TAVR) offers treatment for high-risk patients with complex heart conditions. While mortality rates are notable, it remains a viable option for carefully selected individuals.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- The transaortic (TAo) approach is an alternative to the transapical approach for transcatheter aortic valve replacement (TAVR).
- TAo-TAVR can be utilized in concomitant procedures, offering a less invasive option for complex cardiac interventions.
- This approach is particularly relevant for high-risk patients requiring simultaneous surgical management.
Purpose of the Study:
- To evaluate the safety and efficacy of the transaortic (TAo) approach for transcatheter aortic valve replacement (TAVR) in high-risk patients.
- To assess the outcomes of TAo-TAVR when performed concurrently with other cardiac procedures.
- To determine the feasibility of TAo-TAVR in patients with severe aortic stenosis and coexisting tricuspid valve disease or coronary artery disease.
Main Methods:
- A prospective study involving nine high-risk patients between September 2013 and September 2015.
- Patients had severe aortic stenosis and either tricuspid valve disease or coronary artery disease.
- Treatment involved TAo-TAVR combined with simultaneous tricuspid valve repair or coronary artery bypass grafting.
Main Results:
- Mean postoperative pressure gradient was 13.4 ± 3.2 mmHg at discharge.
- One patient (11.1%) had an aortic regurgitation grade >2/4 and one (11.1%) required a new pacemaker.
- Device success was 88.9%, with 30-day mortality at 11.1% and intermediate mortality at 33.3%.
Conclusions:
- The TAo-TAVR approach provides definitive treatment for high-risk patients with complex cardiac lesions.
- Despite relatively high 30-day and intermediate mortality rates, it is a valuable option for select high-risk patients.
- This approach facilitates simultaneous interventions, addressing multiple cardiac issues in a single procedure.
Introduction:
The transaortic (TAo) approach has been proposed as an alternative to the transapical approach and can be used in concomitant procedures. We use the TAo transcatheter aortic valve replacement (TAVR) with other simultaneous cardiac procedures in high-risk patients who needed surgical management.
Materials And Methods:
Between September 2013 and September 2015, nine consecutive high-risk patients with severe aortic valve stenosis (AR) and combined tricuspid valve disease or coronary artery disease were treated with TAo TAVR and simultaneous tricuspid valve repair or coronary artery bypass grafting.
Results:
Mean postoperative pressure gradient at discharge was 13.4 ± 3.2 mmHg and AR grade >2/4 was observed in one case (11.1%). New pacemaker implantation was required in one case (11.1%). Device success was achieved in 88.9% (n = 8), 30-day mortality was in 11.1% (n = 1), and intermediate mortality was in 33.3% (n = 3).
Conclusion:
TAo-TAVR approach offers definitive treatment to high-risk patients with coexisting complex cardiac lesions. Despite the relatively high 30-day and intermediate mortality, it is an option for selected high-risk patients.
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:24Cardiac Catheterization III: Left Heart Catheterization
01:25Aortic Regurgitation III: Medical Management