Endovascular aortic aneurysm repair via the left ventricular apex of a beating heart.

An elderly man presented with a ruptured aortic arch, left lung compression, and hemoptysis. Multiple comorbidities and inadequate aortoiliac access disqualified him from conventional open repair or hybrid retrograde transarterial thoracic endovascular aortic repair (TEVAR). Because our center has recently reported that a thoracic aortic endograft can be successfully placed through the apex of the LV of a beating heart in a pig model, we received approval for the compassionate use of antegrade transapical TEVAR (TaTEVAR) with bilateral femoral-carotid revascularization to repair the aortic arch. As in our animal model, TaTEVAR was performed with accuracy and minimal hemodynamic compromise. The patient was quickly weaned from inotropic and respiratory support postoperatively and was neurologically intact, but died on the tenth postoperative day from respiratory failure.