title: Early experience of transaortic TAVI--the future of surgical TAVI?
abstract: BACKGROUND
  Trans-catheter aortic valve implantation (TAVI) is now a well recognised procedure for the high risk surgical patient with native or bioprosthetic aortic valve stenosis. Transfemoral and transapical implantation techniques are well described. With increasing referral of more marginal transapical patients, we describe our experience of a transaortic TAVI approach which we believe reduces the postoperative wound pain, respiratory complications, operative risk and hospital stay.
  
  
  METHODS
  Patients referred for surgical TAVI underwent trans-catheter aortic valve implantation via an upper sternotomy and direct cannulation of the ascending aorta.
  
  
  RESULTS
  Thirteen patients with a mean age of 81 years underwent transaortic Edwards SAPIEN valve implantation. There was no in hospital mortality in our series. One patient required insertion of a permanent pacemaker for complete heart block. There were no aortic cannulation complications.
  
  
  CONCLUSIONS
  The transaortic TAVI approach provides good exposure of the distal ascending aorta, a familiar cannulation site for cardiac surgeons. Our initial experience demonstrates the approach to be a safe technique with the potential for faster and less complicated recovery in patients undergoing surgical TAVI procedures. With further experience and greater acceptance, the transaortic approach may ultimately become the procedure of choice for patients unsuitable for a transfemoral approach.
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia. Andrew_Clarke@health.qld.gov.au
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
authors.forename: Paul
authors.initials: P
authors.lastname: Wiemers
authors.forename: Karl K C
authors.initials: KK
authors.lastname: Poon
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Aroney
authors.forename: Gregory
authors.initials: G
authors.lastname: Scalia
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.forename: Peter
authors.initials: P
authors.lastname: Tesar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D056346:Sternotomy / Q000295:instrumentation / Q000379:methods