Suprasternal Transcatheter Aortic Valve Replacement: A Step-by-Step Video Description

Abstract

SS-TAVR is reserved for patients in whom TF access is not feasible (small size, tortuosity, calcium) or in whom the risk of vascular complication was deemed high (obesity, abdominal or thoracic aortic pathology/atheroma, etc.). Preoperative computerized tomography (CT) is of paramount importance for operative planning. In evaluating candidacy for SS-TAVR, four criteria are required: 1) an innominate artery with an area free of calcium for sheath insertion, 2) a minimum diameter of the innominate artery of 7 mm, 3) limited angulation or tortuosity of the innominate artery and its attachment to the transverse arch, 4) a minimum distance of 7–8 cm from the expected site of sheath insertion to the aortic annulus. These criteria inform preoperative decision-making, but none are strict contraindications. Other relative contraindications to this approach are a deformity of the cervical spine which limits neck extension, and/or patients with a large thyroid mass. Patients with prior cardiac surgery, including coronary artery bypass surgery, prior mediastinoscopy, tracheostomy, neck surgery, mediastinal radiation, or prior carotid interventions are not contraindications to this approach.