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The Transapical Approach for TEVAR
Tamer Ghazy1, Adrian Mahlmann2, Ahmed Ouda1, ralf-Thorsten Hoffmann2, Norbert Weiss2, Klaus Matschke1, Utz Kappert1.
1Dresden Heart Center, Dresden University of Technology, Dresden, Germany, 2University Hospital Carl Gustav Carus Dresden, Dresden, Germany.

OBJECTIVE: To analyse the feasibility of using a transapical approach for TEVAR in patient with unfavorable femoral access.
METHODS: From January 2011 till December 2013, 9 patients received TEVAR in our institution via transapical approach. The indications were distal arch and thoracic descending aneurysms (4 patients), Stanford type B aortic dissection (3 patients), and Penetrating aortic ulcers in 2 patients (one in the descending aorta and the other in the ascending aorta). Preparation of the access point was performed similar to the standard transapical approach for TAVR. Deployment of the stent was performed under rapid ventricular pacing.
RESULTS: The mean operative time was 83±19 min. Overstenting of the left subclavian was necessary in one patient. there were no intraoperative complications, no intra- or postoperative mortality and no postoperative neurological deficit. A postoperative bleeding requiring 2nd look was incountered in 1 patient. The mean ICU stay was 3±2 days. The mean hostpital stay was 9±4 days.
CONCLUSIONS: The transapical approach to TEVAR could be considered an alternative approach. Yet it is to be considered only for highly selected cases. This approach provides a shorter, and an always non-dissected access point for the ascending aorta, allowing for easier and more precise placement in such cases.
Further research is needed to identify the indication, complications and technical difficulties that its use may pose, as well as explore the possibility of encouraging the medical industry to develop suitable stents and delivery systems.

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