Transapical Coronary Artery Intervention “First-in-Man” Experience

The transfemoral and the transradial approach are the standard access routes for coronary angiography and percutaneous coronary interventions. A transapical left ventricular access is sometimes used for diagnostic purposes and has been described for structural cardiac interventions, but not for coronary artery interventions.1–4 A significant number of patients who undergo catheter-based aortic valve implantation also require coronary intervention. In selected cases, it may be desirable to perform coronary revascularization via the transapical access, for example if aortic disease makes a transfemoral or transradial approach impossible or may lead to complications. We report a case of successful transapical coronary intervention in a patient undergoing transapical catheter-based aortic valve implantation. #### Case A 92-year-old male patient with severe symptomatic aortic stenosis (valve area, 0.4 cm2; peak pressure gradient, 87 mm Hg; mean pressure gradient, 47 mm Hg), diabetes, renal failure (epidermal growth factor receptor, 28 mL/min per 1.73 m2), obstructive pulmonary disease, and EURO …