While most keyhole (transcatheter or percutaneous) aortic valve implant procedures are done through an artery in the groin (femoral artery), a significant number of patients have narrowed arteries in the leg or arteries that are too small, thereby precluding this approach.
In this situation, one can directly implant a valve through a small incision on the left chest to directly implant the valve through a small incision at the apex of the heart.
This transapical TAVI procedure requires exceptional surgical skill, as it can be very difficult to stop the heart from bleeding once one has made a significant entry.
In fact, transapical TAVI outcomes worldwide have been uniformly poorer than procedures through the leg. In Australia for example, our group is one of the few groups left practising this approach due to its challenges and poor outcomes in many units.
We have recently published our remarkable transapical TAVI outcomes, reporting zero mortality at 30 days for this procedure in our hands. Our program is the only transapical TAVI program in the world with zero early mortality.
These data are in stark contrast to many other reports, such as the European STACCATO trial of transapical TAVI which was abandoned due to poor outcomes.