Initial experience in Mexico with the Evolut™ R valve with direct aortic Access

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Aortic stenosis (AS) is a prevalent valvulopathy in the elderly, often necessitating surgical intervention.
• Many patients are deemed high-risk or inoperable for traditional heart surgery.
• Transcatheter aortic valve implantation (TAVI) was developed as an alternative for these high-risk individuals.

Observation:

• Limitations in traditional vascular access (femoral, subclavian, axillary) necessitate alternative TAVI approaches.
• The direct aortic approach, while invasive, is technically feasible and familiar to cardiac surgeons.
• This approach has shown favorable outcomes, including reduced complications and shorter ICU stays compared to surgery or transapical access.

Findings:

• The direct aortic approach for TAVI is feasible and safe, even in complex cases like transverse aortic dissection.
• Successful implantation of a self-expandable aortic valve (Evolut™) was achieved via direct aortic access.
• This method offers potential advantages over traditional surgical or transapical TAVI routes.

Implications:

• The direct aortic approach expands TAVI feasibility for patients with challenging vascular anatomy.
• This technique may improve outcomes and reduce complications in high-risk aortic stenosis patients.
• Further adoption of the direct aortic approach could increase TAVI accessibility and patient benefit.