**3.2 Transapical approach**

The first transapical TAVR implantation was performed in 2005 [28]. During first years of TAVR, transapical approach was considered as the first alternative if femoral approach were not feasible. Transapical approach is more invasive than other concepts. Only BEVs are suitable for a transapical approach. Compared to the transfemoral approach, the advantages of the transapical approach are that valve alignment is easier, there are no vascular complications, less fluoroscopy time is required, and less contrast is used. Receiving general anesthesia, postoperative pain and bleeding from left ventricle (results in tamponade) are important limitations.
