Transcathater aortic valve implantation in transapical access

We congratulate Doğan et al. (1) on their successful transcathater aortic valve implantation (TAVI) entitled "Transcatheter aortic valve implantation through extra-anatomic iliac graft in a patient with unsuitable iliofemoral and subclavian anatomy." published in Anatol J Cardiol 2016;16:813-4. The authors report that they conducted the procedure through the synthetic graft, which they anastomosed to the left common iliac artery of the patient as the femoral and subclavian access routes were diseased. They explained why they did not conduct the procedure transapically by referring to the studies of Fröhlich et al. (2). It is reported in this study too that transapical TAVI has higher mortality rates than other methods. However, we are of the opinion that for this patient, the TAVI procedure should be conducted transapically rather than through a synthetic graft in spite of the opposite hypothesis of Doğan et al. (1). There is no consensus on the hypothesis that a transapical attempt is more reliable than a transfemoral attempt. A lot of studies indicate that transapical TAVI is at least as reliable as other access routes (3–5). In one of these studies, it is even stated that the transapical approach is better than the transfemoral approach in terms of postoperative paravalvuler leakage (4). In another study, the transapical approach has been found to offer a better manoeuvre ability than the transfemoral approach during prosthesis placement (5).