How to Perform a Simplified Technique for Transapical Aortic Valve Implantations

Abstract

Transcatheter aortic valve implantation has become the treatment of choice for inoperable and high-risk patients with severe aortic stenosis. Procedures have widely evolved in the 15 years since the first transcatheter transfemoral valve implantation. In this article, we describe a minimal approach of transapical transcatheter aortic valve implantation using the Edwards Sapien 3 valve and the Certitude system delivery. This approach allows for the implantation of a transcatheter heart valve without peripheral vascular access in patients with severe vascular disease. By not using a right ventricular pacing lead, the risk of ventricle perforation is avoided. The volume of injected contrast media is drastically reduced, which is of particular interest for patients with renal insufficiency. The simplification of the procedure using fewer catheterization maneuvers minimizes bleeding. Finally, the absence of retrograde crossing of the aortic arch decreases the risk of cerebral embolization and aortic dissection.