Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 8;37(5):765-768.
doi: 10.21470/1678-9741-2021-0553.

Tips and Tricks in Transaortic TAVR

Marco Gennari  1 , Piero Trabattoni  1 , Marco Agrifoglio  1   2 , Gianluca Polvani  1   2 , Maurizio Roberto  1
Affiliations

Tips and Tricks in Transaortic TAVR

Marco Gennari et al. Braz J Cardiovasc Surg. .

Abstract

Transfemoral transcatheter aortic valve replacement (TAVR) is currently the standard catheter-based treatment of severe aortic stenosis patients. Being the transfemoral route not feasible, other access sites could be chosen. Transaortic TAVR via either a J mini-sternotomy or a right anterolateral mini-thoracotomy is a good option for patients having tricky thoracoabdominal aorta. Some tips and tricks may help in getting a fast and safe transaortic procedure.

Keywords: Aortic Valve Stenosis; Aortic Valve Stenosis.; Sternotomy; Thoracotomy; Transcatheter Aortic Valve Replacement.

PubMed Disclaimer

Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Schematic panel of the hybrid operating room setting for transaortic transcatheter aortic valve replacement (TAVR). The C-arm (A) is classically oriented as per transfemoral TAVRs, but the screen is moved to the patients’ feet (B). First operator, assistant, and eventually third operator (1, 2, and 3) are located in a standard surgical position. We routinely utilize three tables (C, D, and E) for valve preparation, surgical, and percutaneous instruments, respectively. The latter table is also useful for harboring the prepared delivery system. The nurses are at the right side of the operator (4) and at the head of the patient (5). The anesthetist (6) and, if needed, the cardiologist with an echocardiographer (7) are at the right head-side and left-head side of the patient, respectively. A running cardiopulmonary bypass (H) is present at the entrance of the operating room. F is the echo machine.
Fig. 2
Fig. 2
The 6-Fr sheath for the pigtail catheter is passed transcutaneously to stabilize the catheter-sheath unit (yellow arrow). Triple large purse-string sutures are performed on the ascending aorta at proper distance (green arrow).
Fig. 3
Fig. 3
(A) Delivery sheath in place. (B) Final result after sutures tightening (green arrow).
See this image and copyright information in PMC

References

    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–2791. doi: 10.1093/eurheartj/ehx391.. - DOI - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–1705. doi: 10.1056/NEJMoa1814052.. - DOI - PubMed
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706–1715. doi: 10.1056/NEJMoa1816885.. - DOI - PubMed
    1. Bapat V, Frank D, Cocchieri R, Jagielak D, Bonaros N, Aiello M, et al. Transcatheter aortic valve replacement using transaortic access: experience from the multicenter, multinational, prospective ROUTE registry. JACC Cardiovasc Interv. 2016;9(17):1815–1822. doi: 10.1016/j.jcin.2016.06.031.. - DOI - PubMed
    1. Bapat V, Khawaja MZ, Attia R, Narayana A, Wilson K, Macgillivray K, et al. Transaortic transcatheter aortic valve implantation using Edwards Sapien valve: a novel approach. Catheter Cardiovasc Interv. 2012;79(5):733–740. doi: 10.1002/ccd.23276.. - DOI - PubMed