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Alternative access for balloon-expandable transcatheter aortic valve replacement: Comparison of the transaortic approach using right anterior thoracotomy.

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Presentation on theme: "Alternative access for balloon-expandable transcatheter aortic valve replacement: Comparison of the transaortic approach using right anterior thoracotomy."— Presentation transcript:

1 Alternative access for balloon-expandable transcatheter aortic valve replacement: Comparison of the transaortic approach using right anterior thoracotomy to partial J- sternotomy  Kazuaki Okuyama, MD, Hasan Jilaihawi, MD, James Mirocha, MS, Mamoo Nakamura, MD, Danny Ramzy, MD, PhD, Raj Makkar, MD, Wen Cheng, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 149, Issue 3, Pages (March 2015) DOI: /j.jtcvs Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Surgical incision for each access. Right anterior thoracotomy is performed through the second intercostal space for a transaortic (TAo) approach using the thoracotomy (T-TAo) (left panel). Partial J-sternotomy is performed through the right second intercostal space for a TAo approach using the sternotomy (S-TAo) (left panel). Left lateral thoracotomy through the sixth or fifth intercostal space is performed for a transapical approach (TA) (right panel). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Retrospective computed tomography assessment. A, Assessment for transaortic transcatheter aortic valve replacement (TAo TAVR) assuming partial J-sternotomy. B, Assessment for TAo TAVR assuming right anterior thoracotomy. A (i) and B (i), Virtual sheaths through the access point on the aorta to the center of the annulus. A (ii) and B (ii), The access point for sternotomy is defined as the site behind the sternum at the second intercostal space (ICS) and the access point for thoracotomy is defined as the right-anterior border of the aorta at the second ICS. The distance between skin and the access point is shown (arrows). A (iii) and B (iii), Annulus entrance angle and the distance between the access point and the annulus (arrows). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Case of transaortic (TAo) transcatheter aortic valve replacement (TAVR) through a small calcium-free space in a heavily calcified aorta. Volume-rendering view (A) and maximum-intensity projection (B) show a small calcium-free space measuring 14.5 mm × 11.6 mm in the ascending aorta. C, A virtual 24F sheath is placed. D, TAo TAVR is performed with a 24F Ascendra + delivery system (Edwards Lifesciences). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Case of transaortic transcatheter aortic valve replacement of horizontal aorta with anterior thoracotomy. A, Ascending aorta is right-shifted in the level of the second intercostal space. B, Coronal view shows angulated aorta. C, Virtual sheath is placed. D, Fluoroscopic image shows the coaxial approach with anterior thoracotomy. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

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