Transapical Antegrade Ascending Aorta Stent-Grafting: Going Through the Front Door

Objective: Ascending aorta stent-grafting (AASG) is a new option that has shown initial promising results. In selected cases, when neither conventional surgery nor transfemoral retrograde approach are feasible, antegrade transapical (TA) access can be performed. The aim of this single-center retrospective study was to evaluate outcomes of patients undergoing AASG through a TA approach. Methods: We analyzed all patients undergoing AASG through a TA approach at our institution. Three different devices were used, including Relay Stent-Graft System (Terumo Aortic, UK), Gore Conformable Thoracic Aortic Graft (W. L. Gore & Associates, Inc., USA), and Valiant Thoracic Stent Graft (Medtronic, Ireland). All patients underwent clinical and computed tomographic angiogram (CTA) evaluation before hospital discharge. Results: From May 2010 to December 2019, 3 consecutive patients underwent AASG at our institution. Mean age was 69 years. Three different types of endografts were used in 1 patient each. All patients stayed in the intensive care unit for 24 hr and mean hospital stay was 12 days. We did not observe any major adverse event. One patient died of pneumonia 2 months after the procedure and the other 2 patients are alive and in good clinical conditions at a mean follow-up of 56 months. Predischarge CTA showed good anatomic results with no endoleaks in all cases. Conclusions: This initial experience shows that AASG is feasible and provides encouraging clinical and anatomic results in selected high-risk patients.