title: Transaortic Transcatheter Aortic valve implantation using Edwards Sapien valve: a novel approach.
abstract: OBJECTIVE
  To evaluate feasibility and outcome of Transoartic Transcatheter Sapien valve implantation.
  
  
  BACKGROUND
  Transcatheter Aortic valve implantation (TAVI) using the Edwards SAPIEN device (Edwards LifeScience, Irvine, CA) is usually performed via the transfemoral (TF) or transapical (TA) routes. Some patients are not suitable for these approaches. We report our experience with the novel transaortic (TAo) approach via a partial upper sternotomy and discuss the advantages and future applications.
  
  
  METHODS
  Between January 2008 to March 2011 193 patients with severe aortic stenosis underwent TAVI with the Edwards SAPIEN bioprosthesis at the St. Thomas' Hospital, London. 108 patients were unable to undergo a TF-TAVI and of those 17 were accepted for a TAo-TAVI on the basis of anatomy, risk, LV function, and significant respiratory disease.
  
  
  RESULTS
  The TAo-TAVI group (n = 17) had more prevalent respiratory disease than the TA-TAVI group (47.0% vs. 18.7%, P = 0.011). Otherwise the groups were similar in demographics and history. Despite this the 30 day mortalities were not significantly different between the groups (TAo-TAVI 4.3% at 30 days versus TA-TAVI 7.7%, P = 0.670). There were no significant differences in procedural complications.
  
  
  CONCLUSIONS
  The TA-TAVI approach may not be desirable in patients with severe chest deformity, poor lung function or poor left ventricular function. TAo-TAVI via a partial sternotomy is safe and feasible in these patients.
authors.affiliation: Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom. vnbapa-t@yahoo.com
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
authors.forename: Muhammed Z
authors.initials: MZ
authors.lastname: Khawaja
authors.forename: Rizwan
authors.initials: R
authors.lastname: Attia
authors.forename: Ashok
authors.initials: A
authors.lastname: Narayana
authors.forename: Karen
authors.initials: K
authors.lastname: Wilson
authors.forename: Kirsty
authors.initials: K
authors.lastname: Macgillivray
authors.forename: Christopher
authors.initials: C
authors.lastname: Young
authors.forename: Jane
authors.initials: J
authors.lastname: Hancock
authors.forename: Simon
authors.initials: S
authors.lastname: Redwood
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography; D006113:United Kingdom