Transaortic access is the key to success.

Transcatheter aortic valve implantation (TAVI) using either the Edwards SAPIEN Valve or Medtronic CoreValve is a well-established procedure. Although initially carried out through transfemoral and transapcial approaches, alternative approaches have become popular and have been utilised to optimise the outcomes. The transaortic (TAo) approach can be used for both these devices and is carried out through the ascending aorta, which can be approached through a partial upper J-sternotomy, T-sternotomy or a right anterior thoracotomy. Due to its familiarity, this procedure is within the comfort zone of surgeons which reduces the learning curve as well as access site-related complications. There are also other potential advantages to the TAo approach, which make it versatile and less invasive. These advantages, indications, contraindications, surgical technique and results will be discussed in this paper. The ongoing ROUTE registry (SAPIEN multicentre European TAo registry), prospective CoreValve multicentre European registry and data from a pivotal trial for CoreValve in the United States will certainly provide robust data in confirming the various advantages seen in centres utilising this approach. Dedicated TAo delivery systems, which could also be used for the subclavian approach, are on the horizon for the newer devices which are currently implanted through other approaches.