title: Short-Term Outcomes with Direct Aortic Access for Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  Transcatheter aortic valve replacement (TAVR) requires a safe route of access to the aortic valve. A direct aortic route has been used as alternate access approach in patients where ileo-femoral access is unsafe due to size, calcification and/or tortuosity. The study aim was to review the authors' results obtained with a direct aortic (DA) TAVR, examining in particular the safety and effectiveness of this approach.
  
  
  METHODS
  A retrospective analysis was performed of all prospectively collected TAVR data from January 2011 to March 2015 at the authors' institution. DA-TAVRs were performed using either an upper mini- sternotomy (MST) into the second right intercostal space, or via a right anterior mini-thoracotomy (RAT) at the second intercostal space. The choice between MST and RAT approaches was made by the surgeon, based on aortic imaging, patent bypass grafts and pulmonary function. Both, Medtronic CoreValve and Edwards SAPIEN devices were used. All relevant perioperative and clinical outcomes were collected based on Valve Academic Research Consortium 2 (VARC-2) definitions. Median numerical values were used.
  
  
  RESULTS
  Seventy-eight consecutive patients underwent DA-TAVR with 100% intraoperative survival and 92% 30-day survival. The procedural success was 97%. The majority of patients (79%) underwent DA-TAVR with the Medtronic CoreValve, via MST (92%). All patients were classified either as extreme (74%) or high risk (26%) for surgical aortic valve replacement.
  
  
  CONCLUSIONS
  DA-TAVR provides a safe and viable alternate access approach for patients with inadequate ileo-femoral access. The clinical outcomes were acceptable in this very high-risk group of patients.
authors.forename: Basel
authors.initials: B
authors.lastname: Ramlawi
authors.forename: Walid K
authors.initials: WK
authors.lastname: Abu Saleh
authors.forename: Odeaa Al
authors.initials: OA
authors.lastname: Jabbari
authors.forename: Colin
authors.initials: C
authors.lastname: Barker
authors.forename: Chun
authors.initials: C
authors.lastname: Lin
authors.forename: Manuel
authors.initials: M
authors.lastname: Reyes
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Michael T
authors.initials: MT
authors.lastname: Reardon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D011677:Punctures; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D013781:Texas; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome