Transcatheter aortic valve implantation via transaortic access: a bail-out strategy in unexpectedly inoperable patients

Transcatheter aortic valve implantation is a procedure reserved for patients with severe aortic stenosis and high operative risk. Minimization of surgical trauma and avoidance of cardiopulmonary bypass makes this procedure interesting for bail-out situations of unexpectedly inoperable patients.

We describe two cases of transcatheter aortic valve implantation via transaortic access in patients with intraoperatively diagnosed contraindications to conventional aortic valve replacement.

In the first case, the procedure was performed via median sternotomy in order to allow central cannulation for extracorporeal circulation in a patient without access vessels for peripheral cannulation. In the second patient, the procedure was performed in a minimally invasive fashion via upper partial sternotomy. Both procedures were performed using a transapical sheath and an upside down mounted transcatheter aortic valve prosthesis.

Transaortic valve implantation can be successfully used for unexpectedly inoperable patients even without previous evaluation for transcatheter valve implantation.