Transapical Endovascular Aortic Repair to Treat Complex Aortic Pathologies

Transapical Endovascular Repair with a Table‐Tailored Endograft to Treat Ascending Aortic Dissection

“…A variety of stent grafts via the retrograde access have been reported to repair the ascending aortic pathology. 1,6,7 However, based on the measurement in our patient, all available commercial thoracic devices were too long to fit the dimension of our patient. A tabletailor stent graft had to be trimmed and reloaded.…”

“…Most pathologies involving the ascending aorta are considered unsuitable for current endovascular treatment because of the unique anatomy of the ascending aorta. The relative short distance from the coronary arteries and aortic valve leaflets proximally to the brachiocephalic trunk distally, the curved anatomy and high flow characteristics in the ascending aorta usually make precise deployment of the stent graft challenging . The primary design of the current devices to treat descending thoracic aortic pathology often precludes its use in ascending aortic pathology.…”

“…Hybrid thoracic endovascular aortic repair through a left anterior minithoracotomy has been described. Cerebrovascular and respiratory complications occurred, however, in more than 28% of patients . Despite a successful outcome, potential complications include left ventricular apex rupture and aortic valve incompetence.…”

“…The relative short distance from the coronary arteries and aortic valve leaflets proximally to the brachiocephalic trunk distally, the curved anatomy and high flow characteristics in the ascending aorta usually make precise deployment of the stent graft challenging. 6 The primary design of the current devices to treat descending thoracic aortic pathology often precludes its use in ascending aortic pathology. In the retrograde deployment, the delivery systems are usually too short to reach the ascending aorta.…”

Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access

“…With the introduction of TAVR, the apex of the LV has gained popularity as the largest on ramp to the vascular highway. In 2009, Grenon and colleagues [4] first reported the use of transapical access for TEVAR in a pig model, with subsequent human case reports following [5][6][7][8].…”