title: Endovascular aortic aneurysm repair via the left ventricular apex of a beating heart.
abstract: An elderly man presented with a ruptured aortic arch, left lung compression, and hemoptysis. Multiple comorbidities and inadequate aortoiliac access disqualified him from conventional open repair or hybrid retrograde transarterial thoracic endovascular aortic repair (TEVAR). Because our center has recently reported that a thoracic aortic endograft can be successfully placed through the apex of the LV of a beating heart in a pig model, we received approval for the compassionate use of antegrade transapical TEVAR (TaTEVAR) with bilateral femoral-carotid revascularization to repair the aortic arch. As in our animal model, TaTEVAR was performed with accuracy and minimal hemodynamic compromise. The patient was quickly weaned from inotropic and respiratory support postoperatively and was neurologically intact, but died on the tenth postoperative day from respiratory failure.
authors.affiliation: Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada. smacdonald@providencehealth.bc.ca
authors.forename: Shaun
authors.initials: S
authors.lastname: MacDonald
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Ravindar
authors.initials: R
authors.lastname: Sidhu
authors.forename: Pascal
authors.initials: P
authors.lastname: Rheaume
authors.forename: S Marlene
authors.initials: SM
authors.lastname: Grenon
authors.forename: Jason
authors.initials: J
authors.lastname: Clement
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D017809:Fatal Outcome; D006352:Heart Ventricles / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome