Transapical Minimally Invasive Aortic Valve Implantation

Abstract

Background-To evaluate initial multicenter results with minimally invasive transapical aortic valve implantation (TAP-AVI) for high risk patients with aortic stenosis. Methods and Results-TAP-AVI was performed via a small anterolateral minithoracotomy with or without femorofemoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN THV, Edwards Lifesciences) was used. Fifty-nine consecutive patients (81Ϯ6 years, 44 female) were operated on from 02/06 until 10/06 at 4 centers using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27Ϯ14%. TAP valve positioning was performed successfully in 53 patients, 4 required early conversion to sternotomy. Implantation (23-mm valves in 19 and 26-mm valves in 40 patients) was performed on the beating heart during brief periods of rapid ventricular pacing. Thirty-one patients were operated on without cardiopulmonary bypass. Neither coronary artery obstruction nor migration of the prosthesis was observed, and all valves had good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 26 patients (trace in 11, mild in 12, and severe in 3). Eight patients died in-hospital (13.6%) without any valve dysfunction. Actuarial survival was 75.7Ϯ5.9% at a follow-up interval of 110Ϯ77 days (range 1 to 255 days). Conclusions-TAP-AVI can be performed safely with good early results in high risk patients. Long-term valve performance as well as broader based applications of this promising approach will need to be studied.

Transapical Versus Transfemoral Aortic Valve Implantation: A Comparison of Survival and Safety

“…This prosthesis is approved for both TF and TA access and is suitable for native annulus sizes of 18 to 25 mm. The TF and TA techniques have been described in detail previously (9)(10)(11). Both procedures were performed by a team of cardiac surgeons and interventional cardiologists/radiologists.…”

Transcatheter Versus Surgical Aortic Valve Replacement

“…replacement, 27,28,30,31,34 the rates of death at 30 days were higher among patients who had undergone transapical placement than among those who had undergone transfemoral placement. Possible reasons for these increased rates in the transapical cohort include an increased rate of coexisting disorders, a more protracted learning curve for surgeons, a smaller number of patients who were evaluated, and important procedural differences.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34] In the randomized Placement of Aortic Transcatheter Valves (PARTNER) trial, a subgroup of patients with aortic stenosis who were not candidates for surgical aortic-valve replacement and who underwent transfemoral placement had an improvement of 20% in the 1-year survival rate and also had reduced symptoms. 35 This report describes results for the highrisk subgroup of patients in the PARTNER trial who were still candidates for surgical valve replacement and who were randomly assigned to undergo either transcatheter or surgical replacement of the aortic valve.…”

Percutaneous heart valve interventions: a South African perspective

“…Four patients required early conversion to sternotomy and mild AR was present in 25% of cases. (36) Although it was initially thought that this approach would lead to lower risk of peri-procedural stroke, both approaches have a similar published stroke rate of +/-4%. (37,38) …”