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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Transapical aortic stenting: an initial case series.

Tamer G Ghazy1, Ahmed S Ouda, Ahmed M Mashhour

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Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|November 21, 2016
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Summary
This summary is machine-generated.

The transapical approach offers a feasible alternative for thoracic endovascular aortic repair (TEVAR) when transfemoral access is challenging due to vessel calcification. This method demonstrated 100% procedural success in patients unsuitable for standard TEVAR.

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Transfemoral access is the standard for thoracic endovascular aortic repair (TEVAR).
  • Severe calcification and tortuosity of iliac and femoral arteries can preclude transfemoral TEVAR.
  • Alternative access routes are crucial for patients with complex aortic pathologies.

Purpose of the Study:

  • To evaluate the safety and efficacy of the transapical approach for TEVAR.
  • To assess the transapical approach as an alternative in patients with unsuitable transfemoral access.
  • To determine the feasibility of transapical TEVAR for ascending aorta pathologies.

Main Methods:

  • Retrospective review of eight patients undergoing transapical TEVAR (TaTEVAR).
  • Procedures performed in a hybrid operating room via left mini-thoracotomy.
  • Stent graft implantation in the proximal descending or ascending aorta under rapid ventricular pacing.

Main Results:

  • 100% procedural success rate with no intraoperative complications.
  • No 30-day mortality observed.
  • One case of type 1B endoleak occurred, requiring surgical repair after one year.

Conclusions:

  • Transapical TEVAR is a viable option for patients with challenging distal vasculature.
  • The transapical approach may be particularly advantageous for TEVAR involving the ascending aorta.
  • This approach expands treatment options for complex thoracic aortic disease.