Transapical TAVI in Left Ventricular Apical Aneurysm.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) is standard for severe aortic stenosis, with transfemoral (TF) access preferred.
• Transapical (TA) TAVI is typically avoided in left ventricular (LV) apical aneurysms due to rupture risk.
• Complex patient profiles often necessitate alternative TAVI access strategies.

Purpose of the Study:

• To report the first case of transapical TAVI performed from an LV apical aneurysm.
• To demonstrate the feasibility of TA TAVI in challenging anatomical conditions.
• To challenge the contraindication of TA TAVI in LV apical aneurysms.

Main Methods:

• A patient with severe bicuspid aortic stenosis and failed TF access underwent TA TAVI.
• The procedure involved accessing the LV apex through an aneurysm sac despite fibrosed myocardium.
• A 29mm Edwards Sapien S3 Ultra valve was successfully deployed.

Main Results:

• Successful implantation of the TAVI valve with trivial paravalvular regurgitation.
• Stable postoperative recovery was achieved.
• The procedure demonstrated TA TAVI feasibility in an LV apical aneurysm.

Conclusions:

• Transapical TAVI can be safely performed in patients with LV apical aneurysms.
• LV apical aneurysms should not be an absolute contraindication for TA TAVI.
• This case expands TAVI access options for complex aortic stenosis patients.