title: Direct aortic transcatheter valve implantation in a porcelain aorta.
abstract: Transcatheter aortic valve implantation has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery, and is generally performed retrogradely with vascular access. However, in certain patients, this access is either not possible or deemed to carry a high risk of vascular injury. We report our experience of a direct aortic approach in a 78-year old man with severe aortic stenosis, excluded from standard aortic valve replacement due to a porcelain aorta, and affected by severe aortic, iliac-femoral, and subclavian arteriopathy, rendering the transfemoral or subclavian approach unemployable.
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy giuseppe.bruschi@fastwebnet.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications* / Q000175:diagnosis
keywords: Aortic valve stenosis; catheterization; heart valve prosthesis implantation