{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:24:56Z","timestamp":1760149496092,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T00:00:00Z","timestamp":1691625600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Transcatheter aortic valve implantation (TAVI) is now a well-established therapeutic option in an elderly high-risk patient cohort with aortic valve disease. Although most commonly performed via a transfemoral route, alternative approaches for TAVI are constantly being improved. Instead of the classical mini-sternotomy, it is possible to achieve a transaortic access via a right anterior mini-thoracotomy in the second intercostal space. We describe our experience with this sternum- and rib-sparing technique in comparison to the classical transaortic approach. Methods: Our retrospective study includes 173 patients who were treated in our institution between January 2017 and April 2020 with transaortic TAVI via either upper mini-sternotomy or intercostal thoracotomy. The primary endpoint was 30-day mortality, and secondary endpoints were defined as major postoperative complications that included admission to the intensive care unit and overall hospital stay, according to the Valve Academic Research Consortium 3. Results: Eighty-two patients were treated with TAo-TAVI by upper mini-sternotomy, while 91 patients received the intercostal approach. Both groups were comparable in age (mean age: 82 years) and in the proportion of female patients. The intercostal group had a higher rate of peripheral artery disease (41% vs. 22%, p = 0.008) and coronary artery disease (71% vs. 40%, p &lt; 0.001) with a history of percutaneous coronary intervention or coronary artery bypass grafting, resulting in significantly higher preinterventional risk evaluation (EuroScore II 8% in the intercostal vs. 4% in the TAo group, p = 0.005). Successful device implantation and a reduction of the transvalvular gradient were achieved in all cases with a significantly lower rate of trace to mild paravalvular leakage in the intercostal group (12% vs. 33%, p &lt; 0.001). The intercostal group required significantly fewer blood transfusions (0 vs. 2 units, p = 0.001) and tended to require less reoperation (7% vs. 15%, p = 0.084). Hospital stays (9 vs. 12 d, p = 0.011) were also shorter in the intercostal group. Short- and long-term survival in the follow-up showed comparable results between the two approaches (30-day, 6-month- and 2-year mortality: 7%, 23% and 36% in the intercostal vs. 9%, 26% and 33% in the TAo group) with acute kidney injury (AKI) and reintubation being independent risk factors for mortality. Conclusions: Transaortic TAVI via an intercostal access offers a safe and effective treatment of aortic valve stenosis.<\/jats:p>","DOI":"10.3390\/jcm12165211","type":"journal-article","created":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T10:52:40Z","timestamp":1691664760000},"page":"5211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter Aortic Valve Implantation by Intercostal Access: Initial Experience with a No-Touch Technique"],"prefix":"10.3390","volume":"12","author":[{"given":"Nina Sophie","family":"Pommert","sequence":"first","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"DZHK\u2014German Centre for Cardiovascular Research, Partner Site Hamburg\/Kiel\/L\u00fcbeck, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-1892","authenticated-orcid":false,"given":"Thomas","family":"Puehler","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"DZHK\u2014German Centre for Cardiovascular Research, Partner Site Hamburg\/Kiel\/L\u00fcbeck, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatim","family":"Seoudy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4329-9087","authenticated-orcid":false,"given":"Katharina","family":"Huenges","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Schoettler","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-7164","authenticated-orcid":false,"given":"Christine","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janarthanan","family":"Sathananthan","sequence":"additional","affiliation":[{"name":"Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada"},{"name":"Centre for Heart Valve Innovation and Division of Cardiology, St. Paul\u2019s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie L.","family":"Sellers","sequence":"additional","affiliation":[{"name":"Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada"},{"name":"Centre for Heart Valve Innovation and Division of Cardiology, St. Paul\u2019s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5524-5844","authenticated-orcid":false,"given":"David","family":"Meier","sequence":"additional","affiliation":[{"name":"Cardiovascular Translational Laboratory, Providence Research & UBC Centre for Heart Lung Innovation, Vancouver, BC V6Z 1Y6, Canada"},{"name":"Centre for Heart Valve Innovation and Division of Cardiology, St. Paul\u2019s Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada"},{"name":"UBC Centre for Cardiovascular Innovation, Vancouver, BC V6Z 1Y6, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8223-2638","authenticated-orcid":false,"given":"Oliver J.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derk","family":"Frank","sequence":"additional","affiliation":[{"name":"DZHK\u2014German Centre for Cardiovascular Research, Partner Site Hamburg\/Kiel\/L\u00fcbeck, 24105 Kiel, Germany"},{"name":"Department of Internal Medicine III (Cardiology, Angiology, and Critical Care), University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9145-3210","authenticated-orcid":false,"given":"Georg","family":"Lutter","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"DZHK\u2014German Centre for Cardiovascular Research, Partner Site Hamburg\/Kiel\/L\u00fcbeck, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1056\/NEJMoa1103510","article-title":"Transcatheter versus surgical aortic-valve replacement in high-risk patients","volume":"364","author":"Smith","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1056\/NEJMoa1200384","article-title":"Two-year outcomes after transcatheter or surgical aortic-valve replacement","volume":"366","author":"Kodali","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or surgical aortic-valve replacement in intermediate-risk patients","volume":"374","author":"Leon","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.athoracsur.2012.04.021","article-title":"Direct aortic access for transcatheter self-expanding aortic bioprosthetic valves implantation","volume":"94","author":"Bruschi","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1016\/j.jacc.2013.02.076","article-title":"The transaortic approach for transcatheter aortic valve replacement: Initial clinical experience in the United States","volume":"61","author":"Lardizabal","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1016\/j.jcin.2016.06.031","article-title":"Transcatheter aortic valve replacement using transaortic access: Experience from the multicenter, multinational, prospective ROUTE registry","volume":"9","author":"Bapat","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.athoracsur.2009.03.070","article-title":"Unexpected complications of transapical aortic valve implantation","volume":"88","author":"Ghodbane","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1016\/j.amjcard.2015.08.035","article-title":"Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry)","volume":"116","author":"Baxter","year":"2015","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1016\/j.jacc.2015.08.881","article-title":"Predictors and impact of myocardial injury after transcatheter aortic valve replacement: A multicenter registry","volume":"66","author":"Ribeiro","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/ejcts\/ezw406","article-title":"Transaortic transcatheter aortic valve implantation as a first-line choice or as a last resort? An analysis based on the ROUTE registry","volume":"51","author":"Bonaros","year":"2017","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"mmt015","DOI":"10.1093\/mmcts\/mmt015","article-title":"Direct aortic transcatheter valve implantation via mini-thoracotomy using the Medtronic CoreValve","volume":"2013","author":"Bruschi","year":"2013","journal-title":"Multimed. Man. Cardiothorac. Surg."},{"key":"ref_12","first-page":"71","article-title":"Minimally invasive aortic valve replacement: The \u201cMiami Method\u201d","volume":"4","author":"Lamelas","year":"2015","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"mmw011","DOI":"10.1093\/mmcts\/mmw011","article-title":"Transaortic transcatheter aortic valve replacement through a right minithoracotomy with the balloon-expandable Sapien 3 valve","volume":"2016","author":"Ferrari","year":"2016","journal-title":"Multimed. Man. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1055\/s-0041-1730449","article-title":"New Intercostal Transcatheter Aortic Valve Replacement Access: No Touch","volume":"71","author":"Lutter","year":"2023","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.ejcts.2010.03.044","article-title":"First successful trans-catheter aortic valve implantation through ascending aorta using Edwards SAPIEN THV system","volume":"38","author":"Bapat","year":"2010","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jtcvs.2016.05.023","article-title":"Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement","volume":"152","author":"Jones","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1007\/s12471-016-0934-3","article-title":"Rationale and design of the Edwards SAPIEN-3 periprosthetic leakage evaluation versus Medtronic CoreValve in transfemoral aortic valve implantation (ELECT) trial: A randomised comparison of balloon-expandable versus self-expanding transcatheter aortic valve prostheses","volume":"25","author":"Abawi","year":"2017","journal-title":"Neth. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/jocs.15257","article-title":"Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation-Early results in 203 patients","volume":"36","author":"Sef","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.jtcvs.2017.09.044","article-title":"Isolated and concomitant minimally invasive minithoracotomy aortic valve surgery","volume":"155","author":"Lamelas","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.amjcard.2012.08.057","article-title":"Incidence and effect of acute kidney injury after transcatheter aortic valve replacement using the new valve academic research consortium criteria","volume":"111","author":"Kodali","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.ejcts.2010.11.034","article-title":"Risk of acute kidney injury after minimally invasive transapical aortic valve implantation in 270 patients","volume":"39","author":"Kempfert","year":"2011","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_23","first-page":"1393","article-title":"A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation","volume":"44","author":"Mehran","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1002\/ccd.22747","article-title":"Echo-guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients","volume":"77","author":"Baranowski","year":"2011","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1093\/icvts\/ivs312","article-title":"Association of transaortic approach and transoesophageal echocardiography as the primary imaging technique for improved results in transcatheter valve implantation","volume":"15","author":"Verhoye","year":"2012","journal-title":"Interact. Cardiovasc. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5211\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:30:23Z","timestamp":1760128223000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/16\/5211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,10]]},"references-count":25,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["jcm12165211"],"URL":"https:\/\/doi.org\/10.3390\/jcm12165211","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,8,10]]}}}