Direct aortic and subclavian access for transcatheter aortic valve replacement: Decision making and technique

can be visualized, the procedure should be undertaken cautiously, because the aorta is located in a deep place between the esophagus and thoracic vertebra. The aortas from which we harvested the adventitia were all normal tissues. Adventitia from aortas with various aortic disorders such as aortic aneurysm, aortic infection, aortic wall calcification, and rare diseases such as Marfan syndrome and Loeys-Dietz syndrome should be excluded. Constructing a no-treatment control group of patients with high BPF risk seems to be a good way to show the effectiveness of this procedure, but this is contrary to medical ethics.