Minimally invasive transaortic transcatheter aortic valve implantation of the CoreValve prosthesis: the direct aortic approach through a mini-sternotomy

Transcatheter implantation of the CoreValve bioprosthesis (Medtronic, Minneapolis, MN, USA) can be performed surgically through a minimally invasive approach: using an upper-J mini-sternotomy to the second or third intercostal space, the ascending aorta is exposed at a convenient location. After placing two purse-string sutures on the ascending aorta at least 7 cm above the aortic valve annulus, the CoreValve delivery system is advanced under fluoroscopy to the optimal position and the valve is deployed. Because of the short distance between the access point and the aortic annulus, positioning of the valve can be done more accurately in comparison with the transfemoral approach. We report a brief description of this surgical technique, its indications and limitations and the short-term results of our first series.