title: Transapical access for thoracic endograft delivery.
abstract: The purpose of this paper is to describe the technique of transapical deployment of a thoracic endograft and to discuss the specifics of this access. The technique of endograft deployment through a transapical access is demonstrated in a patient with a symptomatic 14-cm aortic arch aneurysm. The 73-year-old patient, with concomitant chronic obstructive airway disease and cardiovascular disease, had been denied open surgery. Femoral artery access was deemed contraindicated because of a more distal concomitant type III thoracoabdominal aneurysm, borderline renal failure and heavily calcified iliac arteries. Bilateral iliac-subclavian debranching and thoracic endografting via a combined transapical and left subclavian access successfully excluded the thoracic aortic aneurysm. The patient died within 24 hours postoperatively due to a massive myocardial infarction. In conclusion, transapical access for thoracic endograft delivery is feasible. Combined with complex debranching procedures in a challenging aneurysmal anatomy, it carries a high risk for periprocedural complications.
authors.affiliation: Department of Vascular Medicine, University Heart Center, Hamburg, Germany. tilokoelbel@googlecom
authors.forename: Tilo
authors.initials: T
authors.lastname: Kölbel
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Sebastian William
authors.initials: SW
authors.lastname: Carpenter
authors.forename: Holger
authors.initials: H
authors.lastname: Diener
authors.forename: Axel
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.forename: Eike Sebastian
authors.initials: ES
authors.lastname: Debus
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D008297:Male; D013348:Subclavian Artery; D014057:Tomography, X-Ray Computed