Transapical aortic valve implantation: step by step

Ann Thorac Surg. 2009 Jan;87(1):276-83. doi: 10.1016/j.athoracsur.2008.08.017.


Purpose: Transapical aortic valve implantation is a new minimally invasive technique for beating heart, off-pump, aortic valve implantation in high-risk patients.

Description: The procedure involves antegrade aortic valve implantation using an oversizing technique with direct access and accurate positioning of a stent-based transcatheter xenograft. Procedural steps include placement of femoral arterial and venous access wires, anterolateral mini-thoracotomy, epicardial pacing, and apical pursestring suture placement. Valve positioning is performed under fluoroscopic and echocardiographic guidance during rapid ventricular pacing.

Evaluation: Patient screening, especially regarding native aortic annulus diameter and pattern of calcification, is essential for success. Since imaging is crucial, implantations are optimally performed in a hybrid operative theater by an experienced team of cardiac surgeons, cardiologists, and anesthetists.

Conclusions: The aim of this article is to outline the technical aspects of the new technique of minimally invasive transapical aortic valve implantation.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / surgery*
  • Cardiac Catheterization*
  • Echocardiography, Transesophageal
  • Female
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Humans
  • Male
  • Minimally Invasive Surgical Procedures / methods*
  • Minimally Invasive Surgical Procedures / mortality
  • Patient Selection
  • Prognosis
  • Risk Assessment
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Stents*
  • Survival Analysis
  • Suture Techniques
  • Treatment Outcome