Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.