title: Transapical aortic valve implantation: step by step.
abstract: 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.
authors.affiliation: Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Leipzig, Germany. walt@medizin.uni-leipzig.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Todd
authors.initials: T
authors.lastname: Dewey
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Reinhardt
authors.initials: R
authors.lastname: Becht
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: 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