title: Transaortic approach for transcatheter aortic valve replacement with other concomitant cardiac procedures in high-risk patients.
abstract: BACKGROUND
  The transaortic (TAo) approach has been proposed as an alternative to the transapical approach and can be used in concomitant procedures. We use the TAo transcatheter aortic valve replacement (TAVR) with other simultaneous cardiac procedures in high-risk patients who needed surgical management.
  
  
  METHODS
  Between September 2013 and September 2015, nine consecutive high-risk patients with severe aortic valve stenosis (AR) and combined tricuspid valve disease or coronary artery disease were treated with TAo TAVR and simultaneous tricuspid valve repair or coronary artery bypass grafting.
  
  
  RESULTS
  Mean postoperative pressure gradient at discharge was 13.4 ± 3.2 mmHg and AR grade >2/4 was observed in one case (11.1%). New pacemaker implantation was required in one case (11.1%). Device success was achieved in 88.9% (n = 8), 30-day mortality was in 11.1% (n = 1), and intermediate mortality was in 33.3% (n = 3).
  
  
  CONCLUSIONS
  TAo-TAVR approach offers definitive treatment to high-risk patients with coexisting complex cardiac lesions. Despite the relatively high 30-day and intermediate mortality, it is an option for selected high-risk patients.
authors.affiliation: Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
authors.forename: Michal
authors.initials: M
authors.lastname: Hulman
authors.affiliation: Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
authors.forename: Martin
authors.initials: M
authors.lastname: Bena
authors.affiliation: Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Artemiou
authors.affiliation: Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Gasparovic
authors.affiliation: Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia.
authors.forename: Vladan
authors.initials: V
authors.lastname: Hudec
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D018154:Slovakia / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome