Initial Experience with the Transapical Access for TEVAR

Background The endovascular approach has become a mainstay in the treatment of aortic aneurysms. While the transfemoral approach is most commonly used, it is often inaccessible due to a vascular pathology, such as occlusion, tortuosity or heavy calcifications. The transapical access provides an alternative approach. The goal of this study is to report the feasibility of the transapical approach for total endovascular repair of thoracic aortic aneurysms (TEVAR). Methods Three patients with thoracic aortic aneurysms with inaccessible femoral arteries underwent TEVAR via the transapical approach. For access, the apex of the left ventricle was exposed by a mini-thoracotomy. After left ventricular puncture, a stiff guidewire was placed through the aortic valve into the descending thoracic aorta. All stent grafts were delivered under fluoroscopic guidance. Results All three procedures were technically successful with complete exclusion of the aneurysm without endoleak. One patient suffered spinal ischemia with subsequent paraplegia on day 4 after the procedure. The same patient died on day 43 after the procedure due to esophageal rupture. The two remaining patients did not present procedure-related problems. Conclusion The transapical access is a feasible and safe alternative to the transfemoral route in selected cases scheduled for TEVAR. Key Points  · Transapical TEVAR is a feasible option if the transfemoral route is not accessible.. · Reversed orientation of the stent graft has to be taken into account for procedure planning and graft deployment.. · Care has to be taken in the case of aortic valve vegetation in order to avoid stroke due to downstream embolism.. Citation Format · Mahnken AH, Irqsusi M, Hundt W et al. Initial Experience with the Transapical Access for TEVAR. Fortschr Röntgenstr 2017; 189: 760 - 764.