Suprasternal Aortic Valve Replacement: Key Technology and Techniques.

Abstract

Suprasternal transcatheter aortic valve replacement offers patients, with unsuitable femoral artery anatomy, an alternative to transapical, direct aortic, and subclavian approaches. The Transit System (Aegis Surgical, Galway, Ireland) enables transcatheter aortic valve replacement directly into the ascending aorta or innominate artery through a small, suprasternal incision. The valve introducer sheath is inserted through a standard pursestring suture, which facilitates secure arterial closure. The proximity to the aortic valve promotes precise control. Proper patient selection and preoperative imaging is essential. A heart team working collaboratively in a hybrid operating room ensures procedural success. Using this approach, four different manufacturer's transcatheter valves have been used successfully. Suprasternal transcatheter aortic valve replacement is a safe and effective addition to the surgeon's armamentarium.