title: Transcatheter aortic valve implantation using a direct aortic approach: a single-centre Heart Team experience.
abstract: OBJECTIVE
  The transaortic (TAo) approach has been introduced as an alternative to transapical and transaxillary aortic valve implantation for patients with symptomatic severe aortic stenosis in whom a transfemoral approach is not feasible. However, only very limited data from a minimal number of specialized centres are available on this approach. Therefore, the aim of this study was to evaluate the early postoperative 30-day outcomes of the direct aortic approach performed by a single-centre multidisciplinary Heart Team.
  
  
  METHODS
  Between May 2011 and July 2013, 159 patients underwent transcatheter aortic valve implantation (TAVI) at our institution; of which, 44 were believed to benefit most from the TAo as assessed by a multidisciplinary Heart Team. All patients underwent an upper 'J' median hemi-sternotomy through a 6-cm incision. The evaluation of early operative results was made according to the Valve Academic Research Consortium (VARC) consensus criteria. These include device success endpoints and combined safety endpoints at 30 days.
  
  
  RESULTS
  The mean age of the patients was 78 years, the mean logistic EuroSCORE was 25.9 ± 14.4% and the mean Society of the Thoracic Surgeons score 5.8 ± 4.5%. Seventeen patients (39%) underwent redo operations; 4 (9%) received a transcatheter valve in a degenerated bioprosthesis. The procedure was performed using the Medtronic CoreValve Revalving system in 36 patients, with the Edwards SAPIEN XT in 7 cases and the St Jude Medical Portico valve in 1. Device success was achieved in 90.8% of the cases. Complications included; major stroke (n = 1), re-exploration for cardiac tamponade (n = 3), transient renal failure requiring temporary haemodialysis (n = 1) and permanent pacemaker implantation (n = 5). There were no myocardial infarctions. The total 30-day mortality rate was 6.8% (3 patients). Postoperative intensive care unit stay was 2.6 ± 3.6 days, and the mean hospitalization was 12 ± 9.6 days.
  
  
  CONCLUSIONS
  The TAo TAVI approach is feasible and offers a safe alternative for patients in whom a transfemoral approach is not feasible or desirable.
authors: Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands hafid.amrane@znb.nl.
authors: Hafid
authors: H
authors: Amrane
authors: Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
authors: Fabiano
authors: F
authors: Porta
authors: Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
authors: Ad J
authors: AJ
authors: van Boven
authors: Department of Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
authors: Piet W
authors: PW
authors: Boonstra
authors: Department of Cardiology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands.
authors: Sjoerd H
authors: SH
authors: Hofma
authors: Department of Cardiothoracic Surgery, Erasmus Medisch Centrum, Rotterdam, Netherlands.
authors: Stuart J
authors: SJ
authors: Head
authors: Department of Cardiothoracic Surgery, Erasmus Medisch Centrum, Rotterdam, Netherlands.
authors: Arie P
authors: AP
authors: Kappetein
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D010348:Patient Care Team; D011474:Prosthesis Design; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Aortic stenosis; Direct aortic; Transaortic; Transcatheter aortic valve implantation