Transcatheter aortic valve replacement using the transaortic approach.

This is a frail 73-year-old male with symptomatic critical aortic stenosis (AS). He has suffered a significant functional decline with associated shortness of breath and chest discomfort. His past medical history is significant for coronary artery disease with prior bypass grafting, porcelain aorta, chronic kidney disease-stage III, diabetes mellitus, hypertension, hyperlipidemia, and peripheral arterial disease. Echocardiography demonstrates tri-leaflet, calcific AS with an aortic valve area of 0.7 cm, a jet velocity of 5.0 m/s, and a mean gradient of 60 mmHg. Cardiac catheterization reveals a widely patent LIMA-to-LAD with patent vein grafts and limited native coronary flow.