title: Transapical aortic stenting: an initial case series.
abstract: OBJECTIVE
  The standard approach for thoracic endovascular aortic repair (TEVAR) is transfemoral; however, calcifications and tortuosity of the access vessels might be so extensive as to increase the operative risk markedly or preclude the procedure. This study evaluates the transapical approach as an alternative route for TEVAR in such patients.
  
  
  RESULTS
  From June 2011 to July 2013, the institution's interdisciplinary board for aortic diseases initially denied TEVAR for eight patients with thoracic aortic pathology due to extensive calcification and tortuosity of the distal vessels. The transapical approach was suggested and approved by the board. All procedures were performed in a hybrid operating room through a left mini-thoracotomy. The stent grafts were implanted in either the proximal descending or the ascending aorta. The deployment was performed under rapid ventricular pacing. Procedural success was 100%. There were no intraoperative complications. One patient needed re-exploration. There was no 30-day mortality. In follow-up, one patient suffered type 1B endoleak, which required surgery after one year.
  
  
  CONCLUSIONS
  The transapical approach for TEVAR (TaTEVAR) is a feasible option for patients with distal aorta/iliac vessels unsuitable for transfemoral access. It might be even more beneficial for TEVAR of the ascending aorta.
authors.affiliation: Department of Cardiac Surgery, Heart Center Dresden University Hospital, Dresden Technical University, Dresden, Germany.
authors.forename: Tamer G
authors.initials: TG
authors.lastname: Ghazy
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Ouda
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Mashhour
authors.forename: Manuel
authors.initials: M
authors.lastname: Wilbring
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
authors.forename: Utz W
authors.initials: UW
authors.lastname: Kappert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome