title: Transaortic transcatheter aortic valve replacement through a right minithoracotomy with the balloon-expandable Sapien 3 valve.
abstract: Transaortic transcatheter aortic valve replacement performed through a right anterolateral minithoracotomy at the second intercostal space is a safe and standardized minimally invasive procedure carrying important clinical advantages for the patient, in particular, no damage to the ventricular apex, preservation of the diseased peripheral arteries and no cross of the aortic arch with the delivery system, meaning a lower risk of calcium dislodgement and neurological complications. Using the third-generation, balloon-expandable Edwards Sapien™ 3 transcatheter heart valve and the Certitude™ delivery system, the transaortic procedure is easily performed under fluoroscopic and echocardiographic guidance. Compared with the transapical procedure, the transaortic technique requires an inversely mounted stent valve and follows the standard guidelines for valve positioning and deployment under rapid pacing. The transaortic approach through a right anterolateral minithoracotomy at the second intercostal space combines the positive aspects of both transfemoral and transapical valve replacements without the risks of either procedure (left ventricular, coronary and peripheral vascular injuries).
authors.affiliation: The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland enricoferrari@bluewin.ch.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferrari
authors.affiliation: The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.affiliation: The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Demertzis
authors.affiliation: The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Moccetti
authors.affiliation: The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Moccetti
authors.affiliation: The Heart-Team, Cardiocentro Ticino Foundation, Lugano, Switzerland.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pedrazzini
authors.affiliation: The Heart-Team, University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Eeckhout
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D006801:Humans; D011474:Prosthesis Design; D013908:Thoracotomy / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods
keywords: Aortic valve stenosis; Transaortic transcatheter aortic valve replacement; Transcatheter aortic valve replacement