title: Transapical Endovascular Repair of Thoracic Aortic Pathology.
abstract: BACKGROUND
  Alternative access for thoracic endovascular aortic repair (TEVAR) has been explored for patients with unsuitable femoral and iliac access, but few cases of transapical access have been described. We report our experience with transapical access for various aortic pathologies.
  
  
  METHODS
  We reviewed 6 cases undergoing transapical access for endovascular repair of thoracic aortic pathology between December 2013 and August 2015. Five patients had an aortic arch aneurysm and 1 patient presented with Stanford type A subacute aortic dissection. Transapical access was indicated to avoid approach through the severely atherosclerotic thoracic descending aorta in 4 patients and severely kinked aorta in 1 patient and to treat an ascending aortic dissection lesion in 1 patient.
  
  
  RESULTS
  Transapical endografting was completed in all patients. Significant aortic valve regurgitation occurred in 3 patients when a large bore sheath was placed across the aortic valve. There was 1 death attributed to global cerebral ischemia due to carotid dissection after carotid bypass and chimney stent-graft insertion. There were no access-related complications. Computed tomography revealed complete exclusion of the aortic aneurysm in 4 patients, and shrinkage of the false lumen in 1 patient with aortic dissection.
  
  
  CONCLUSIONS
  Transapical access for TEVAR would be a potential alternative when the anatomy is unfit for routine retrograde approach. This method might have potential benefit of reducing the risk of embolism in patients with severe atherosclerotic thoracic descending aorta. However, certain safety concerns must be addressed, including maintenance of hemodynamics, wire exteriorization for navigation of the device tip, and rapid pacing during deployment.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. Electronic address: takashimurakami24@hotmail.com.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Hosono
authors.affiliation: Department of Cardiovascular Surgery, Chibanishi General Hospital, Chiba, Japan.
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Etsuji
authors.initials: E
authors.lastname: Sohgawa
authors.affiliation: Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome