title: Transapical aortic valve replacement through a chronic apical aneurysm.
abstract: Transapical aortic valve replacement through an apical aneurysm is traditionally contraindicated because of the risk of severe systemic embolization when thrombi are present. However, a chronic fibrotic aneurysm without apical thrombi carries a low risk of distal embolization and can be safely employed for a transapical transcatheter aortic valve replacement in case of absence of an alternative access site (severe vascular disease, small vascular sizes and diseased calcified aorta). We illustrate our experience with a 73-year-old patient suffering from symptomatic aortic valve stenosis, coronary artery disease with occluded left anterior descending artery, left ventricular apical aneurysm and severe peripheral vascular disease, who successfully underwent a transapical 26 mm Sapien™ XT stent-valve implantation through the fibrotic thin akinetic apical wall.
authors.affiliation: Department of Cardiovascular Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland. enricoferrari@bluewin.ch
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gronchi
authors.forename: Salah Dine
authors.initials: SD
authors.lastname: Qanadli
authors.forename: Ludwig Karl
authors.initials: LK
authors.lastname: von Segesser
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D002908:Chronic Disease; D003323:Coronary Aneurysm / Q000150:complications / Q000175:diagnosis*; D017023:Coronary Angiography; D003331:Coronary Vessels; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D014057:Tomography, X-Ray Computed