**5.1 Introduction**

Transapical access (**Figure 4**) is the alternative approach for TAVI in patients in whom transfemoral or transsubclavian/transaxillary approach is not feasible.

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myocardium

**5.5 Technique**

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

2.The valve is easily crossed in the antegrade direction (vs. retrograde)

3.Not suitable for patients with significant lung disease (forced expiratory

4.It could be a source of postoperative Left ventricular (LV) pseudoaneurysm,

• Preoperative CT scan chest is needed to identify both the rib space over the apex of the heart and the distance from the sternum to the LV apex

• CPB should be standby, to use in case of emergent conversion to open AVR

• Access to femoral vessels must be done in beginning of case, if femoral vessels are supposed to be used as a bailout CPB cannulation (on the contra lateral side, other than from the femoral arterial access for pigtail aortogram and

• Axillary artery can also be cannulated in case femoral artery is small in size

cannulation is that it gives up the site of access for valve deployment

• It need to be careful while tying the sutures as LV can tear due to friable

• The procedure should be performed in a hybrid operative room

• A final bailout for CPB is transapical cannulation itself putting a long arterial cannula across the aortic valve. The obvious advantage of this approach is that area will already be readily accessible. The disadvantage of the transapical CPB

• Common femoral artery and vein are used for cannulation usually

volume in 1 s <35%) or low ejection fraction (<15–20%) [10]

1.Peripheral vascular anatomy and size are not limitation

4.Shorter time for insertion and lesser contrast use

1.Longer recovery due to thoracotomy

and may impair left ventricular function

• Cannulation sites for CPB must be planned

venous access for ventricular pacing

• It is done under general anesthesia

The transapical approach has the following advantages over other approaches:

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

3.Less paravalvular leaks

**5.2 Advantages**

**5.3 Disadvantages**

2.Bleeding

**5.4 Planning**

**Figure 4.** *Transapical access for TAVI.*

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