**6.5 Technique**


**15**

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

• The patient is heparinized to maintain an ACT 200–250 s

• This is exchanged for a 0.035″ Amplatz extra-stiff J wire

• The appropriate valve sheath is placed 2–4 cm into the aorta

• When the valve is positioned correctly, the valve is deployed

• A small flexible chest tube is placed in the mediastinum

straight soft wire is used to cross the valve

• An 18-gauge needle with a 0.035″ soft J guide wire is passed through the

counter incision in the lower neck and used to puncture the aorta through the

• The needle is exchanged for a 7-F sheath, and a multipurpose catheter with a

• An aortic root aortogram is performed to align all the three leaflets of the aortic

• The valve is placed through the delivery sheath and positioned across the valve

• Once optimal positioning of the valve is confirmed, rapid ventricular pacing at

• Aortograms and TEE is used to assess position and presence of any paravalvu-

• After full assessment, all catheters and wires are removed and the aortic

• A right mini-thoracotomy (through second intercostal space) is an option if a surgeon wants to avoid sternotomy or improve visualization in the case of a

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

*Transaortic right anterior minithoracotomy for TAVI.*

purse strings

**Figure 6.**

valve in same plane

sutures are tightened

• Protamine is administered

160–200 beats/min is started

lar leaks and patency of coronary ostia

• Sternum is closed with stainless steel wires

horizontal or a right-sided aorta

**Figure 5.** *Transaortic access by upper "J" ministernotomy forTAVI.*

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

#### **Figure 6.**

*Vascular Access Surgery - Tips and Tricks*

nulation site to the aortic root

• Preoperative CT scan is done to shows the relationship of the distal ascending aorta to the sternum, calcification, and the distance from the distal aortic can-

• This distance should be ideally >7 cm allowing enough space for the valve

• Supine position with the lower neck remaining exposed for a counter incision

• Femoral arterial access is obtained as routine for placing a pigtail catheter in

• It can be performed by two approaches. The first is through mini-sternotomy (**Figure 5**) and the second is by a right mini-thoracotomy (**Figure 6**).

• An upper ministernotomy is performed with extension to the second intercos-

• Pericardial stay sutures are placed for retraction. The aorta is then inspected to

• It should be free from calcification and at least 6–8 cm from the aortic valve for

• CPB should be standby for any intra operative complication

• It needs a hybrid operating room where fluoroscopy and TEE

• A femoral transvenous pacing lead is placed in the right ventricle

**6.4 Planning**

implantation.

for the delivery sheath

tal space, where the "J" is completed

• Two aortic purse strings are placed

*Transaortic access by upper "J" ministernotomy forTAVI.*

find a suitable place for catheter insertion

• The pericardium is opened

valve deployment

the aortic sinus

**6.5 Technique**

**14**

**Figure 5.**

*Transaortic right anterior minithoracotomy for TAVI.*

