Transaortic balloon-expandable aortic valve implantation

In patients with severe symptomatic aortic valve stenosis who are inoperable or at high risk for surgical aortic valve replacement, transcatheter aortic valve implantation (TAVI) represents an alternative therapeutic strategy.1 Currently, there are 2 commercially available devices: the selfexpandable CoreValve revalving system (Medtronic Inc, Minneapolis, Minn) and the balloon-expandable Sapien XTvalve (Edwards Lifesciences, Irvine, Calif). For the latter, a transapical approach is the first choice in case of unavailable femoral access. However, in patients with severe left ventricular (LV) dysfunction, a surgical approach of the apex can potentially further worsen heart contractility, and the presence of an LV aneurysm with mural thrombi Fromthe Divisions of Cardiac Surgery,a and Cardiology,b University of Padova, Italy. Disclosures: Authors have nothing to disclose with regard to commercial support. Received for publication June 17, 2011; revisions received Nov 17, 2011; accepted for publication Dec 6, 2011; available ahead of print Dec 19, 2011. Address for reprints: Augusto D’Onofrio, MD, Division of Cardiac Surgery, University of Padova, via Giustiniani 2, CAP 35128, Padova, Italy (E-mail: adonofrio@ hotmail.it). J Thorac Cardiovasc Surg 2012;143:1453-5 0022-5223/$36.00 Copyright 2012 by The American Association for Thoracic Surgery doi:10.1016/j.jtcvs.2011.12.005 contraindicates the procedure. Bleiziffer and colleagues2 reported that 1 year after transapical TAVI, a new apical hypo- or akinesia was present in up to 37% of patients, and that because of the apical scar, a significant reduction of the LV ejection fraction was found in 13% of patients. In these patients with ‘‘no access,’’ a subclavian/axillary approach has been described,3 but it is not feasible in case a 29-mm device is necessary or both subclavian arteries are heavily calcified or extremely tortuous. A transaortic implantation has been described using the CoreValve revalving system.4 We describe the technique for 29-mm Sapien XT implantation via a transaortic access.