Transapical aortic valve implantation: step by step.
OBJECTIVE
Transapical aortic valve implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve implantation in high-risk patients.


METHODS
The procedure involves antegrade aortic valve implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing.


RESULTS
Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists.


CONCLUSIONS
The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve implantation.
Walther
Thomas
T
Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Leipzig, Germany. walt@medizin.uni-leipzig.de
Dewey
Todd
T
Borger
Michael A
MA
Kempfert
Jörg
J
Linke
Axel
A
Becht
Reinhardt
R
Falk
Volkmar
V
Schuler
Gerhard
G
Mohr
Friedrich W
FW
Mack
Michael
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D018579:Patient Selection; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013536:Suture Techniques; D016896:Treatment Outcome