Abstract
Median sternotomy with central cannulation is the standard approach to the aortic valve for repair or replacement. Over the last decade, surgical exposure options other than a full sternotomy such as a "J" or "T" partial-sternotomy, or a right "mini" anterior thoracotomy and peripheral cannulation methods have captured the interest of cardiac surgeons in search of a "less invasive, minimal access" approach. Less invasive surgical approaches have reduced pen-operative mortality, ventilatory support time, intensive care unit and hospital stays and total hospital costs. Over the last five years, catheter-based technologies have emerged as viable options for aortic valve replacement in patients previously considered to be too high risk for conventional or minimally invasive aortic valve (MIAV) surgery. Implantation of catheter-mounted prostheses may be performed via the antegrade (femoral vein), retrograde (femoral artery) or transapical (left ventricular apex) route. Each delivery route has potential advantages and disadvantages as well as technical, vascular and mechanical limitations. As technology improves, current and future devices and delivery systems being evaluated should overcome these limitations and provide catheter-based prostheses as a viable therapeutic option for aortic valve replacement.