**3.3 Transaortic approach**

Transaortic approach is a highly invasive procedure compared to other vascular approaches. Transaortic intervention is performed through a right anterior minithoracotomy through an incision in the second intercostal space or mini-sternotomy puncture into the ascending aorta. BE and SE valves are suitable for this approach. Major advantages of this concept are less vascular complications, no necessity for left ventricular puncture and good contractility of valve. Major limitations are the need for general anesthesia, previous cardiac surgery (especially beware of left internal mammary artery (LIMA) and bypass grafts) and porcelain aorta. The distance from cannulation to annulus should be ideally 6–8 cm.
