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Suprasternal direct aortic approach transcatheter aortic valve replacement avoids sternotomy and thoracotomy: first-in-man experience

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

Kiser AC, O'Neill WW, de Marchena E, Stack R, Zarate M, Dager A, Reardon M

Reference

Eur J Cardiothorac Surg. 2015 Nov;48(5):778-84

Published

November 2015

Link

Read the abstract

My Comment

Background

Direct aortic deployment of a transcatheter aortic valve (TAVI) does not require sternotomy or passing the aortic arch with the valve delivery system. It enables placement of large sheaths in the aorta and innominate artery via the suprasternal access. The authors describe the first in human experience with the Suprasternal Aortic Access System (SuprAA System).

Results

  • Four male patients (mean 83 years) underwent TAVI (2 CoreValve, 2 SAPIEN) via a direct transaortic approach under general anaesthesia
  • The innominate artery and aortic arch were exposed by 2.5 cm long incision done above the sternal notch
  • A double purse-string suture was placed at the aorta
  • TAVI valves were deployed under fluoroscopic guidance
  • Haemostasis was achieved in all patients
  • All patients were extubated in operating room

My comments

The first in human results of the SuprAA System for TAVI procedure via the suprasternal access are promising. This approach does not require sternotomy or thoracotomy, however it has all advantages of transapical approach, such as short distance between access site and aortic valve, better control over valve deployment, precision during deployment and avoiding passing the aortic arch with delivery system. This is an innovative method, which provides a new minimally invasive approach for high-risk patients classified for TAVI.

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