Association of transaortic approach and transoesophageal echocardiography as the primary imaging technique for improved results in transcatheter valve implantation.
OBJECTIVE
The transaortic access has been proposed to perform transcatheter aortic valve implantation in patients with no other available access. We hypothesize that its coupling with transoesophageal echocardiographic guidance may further reduce procedure-related morbidity.


METHODS
Transoesophageal echocardiography was adopted as the primary imaging modality to produce high-resolution images and to guide the deployment of the transcatheter valve. This imaging modality allows continuous visualization not only of the prosthesis and of the delivery system, but also of the surrounding anatomical landmarks (aortic annulus, sinotubular junction and anterior mitral leaflet).


RESULTS
We report an initial series of eight patients, who were treated by a transaortic delivery of the transcatheter valve (SAPIEN Valve, Edwards Lifesciences Inc., Irvine, CA, USA) through an upper mini-sternotomy and guided by transoesophageal echocardiography. The procedure was uneventful in all patients; there were no cases of access site morbidity, periprocedural stroke or renal failure.


CONCLUSIONS
The association of the transaortic route and the transoesophageal echo guidance has the potential to improve the results of transcatheter valve implantation, and deserves further investigation.
Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. jean-philippe.verhoye@chu-rennes.fr
Jean-Philippe
JP
Verhoye
Joel
J
Lapeze
Amedeo
A
Anselmi
Erwan
E
Donal
D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D011474:Prosthesis Design; D056346:Sternotomy; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*