**5.5 Technique**


**13**

*Different Sites of Vascular Access for Transcutaneous Aortic Valve Implantation (TAVI)*

• Once the optimal position is confirmed, the valve is deployed during rapid

• The valve delivery apparatus is then removed leaving the stiff wire across the

• TEE and angiography are used to assess valve position and paravalvular leak

• Once satisfactory valve function and position is confirmed, all catheters and wires are removed from the apex, and purse-string sutures are tightened dur-

• The pericardium can be closed partially and a flexible Blake drain is placed in the left pleural space with part of it in the pericardium as well for the drainage

The transaortic approach was originally reported by Bapat et al. [12, 13]. The concept behind this first report was the use of the short transapical TAVI delivery system for the retrograde TAVI implant through the ascending aorta. Since then it has become a valid option in case of severe peripheral vascular disease [14].

1.It avoids thoracotomy which could potentially impedes pulmonary function in

3.It is easier to achieve hemostasis in aorta than in LV due to fragile myocardium

1.It is technically challenging in case of previous sternotomy and internal mam-

4.If needed, direct visualization of the aorta permits rapid cannulation and

It has many practical advantages compared to other approaches:

2.It avoids cannulation of the left ventricular apex

initiation of cardiopulmonary bypass for support

mary artery or saphenous vein grafts for CABG

2.It cannot be used in patients with porcelain aorta [15]

• Protamine is given, and additional pledgeted sutures may be placed for

• Balloon dilation may be performed if there is ≥2+ paravalvular leak

*DOI: http://dx.doi.org/10.5772/intechopen.84533*

ing rapid ventricular pacing

• Thoracotomy wound is closed in layers.

adequate hemostasis

**6. Transaortic access**

**6.1 Introduction**

**6.2 Advantages**

COPD patients

**6.3 Disadvantages**

ventricular pacing

bioprosthesis

• Both transesophageal echocardiography (TEE) and aortic root angiogram under fluoroscopy are used to confirm the position of the valve

*Different Sites of Vascular Access for Transcutaneous Aortic Valve Implantation (TAVI) DOI: http://dx.doi.org/10.5772/intechopen.84533*

