Acquired cardiovascular disease
Transapical aortic valve implantation at 3 years

https://doi.org/10.1016/j.jtcvs.2010.10.063Get rights and content
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Objective

Our objective was to analyze the results of transapical aortic valve implantation in high-risk patients with aortic stenosis at up to 3 years after the procedure.

Methods

A total of 299 patients underwent transapical aortic valve implantation from February 2006 until January 2010 using the Edwards SAPIEN transcatheter xenograft. Mean patient age was 82 ± 6 years and 70% were female. Logistic EuroSCORE and Society of Thoracic Surgeons score predicted risks for mortality were 31% ± 16% and 12% ± 8%, respectively. All patients were treated in a hybrid operative theater by a team of anesthetists, cardiologists and cardiac surgeons.

Results

Successful valve implantation was performed in all patients. Transapical aortic valve implantation was uneventful in 267 patients (89.3%), whereas 32 patients (10.7%) required additional interventions. Such interventions included cardiopulmonary bypass support in 18, implantation of a second SAPIEN valve in 15, coronary intervention in 9, conversion to conventional surgery in 6, and annulus perforation in 3 patients (not mutually exclusive). Intraprocedural stroke was not observed in any patient, although 2 (0.7%) patients had a delayed stroke during their hospital stay. Overall survival was 91% at 30 days, 73% at 1 year, 68% at 2 years, and 58% at 3 years.

Conclusions

Transapical aortic valve implantation can be performed with good outcomes in high-risk patients with aortic stenosis. Perioperative complications occur in approximately 10% of patients, and a variety of interventions are required for these events. We believe a team approach is therefore essential for the success of transapical aortic valve implantation

CTSNet classification

35.2
35.3

Abbreviations and Acronyms

AVI
aortic valve implantation
AS
aortic stenosis
AVR
aortic valve replacement
CPB
cardiopulmonary bypass
FEV1
functional expiratory volume in 1 second
STS
Society of Thoracic Surgeons
T-AVI
transcatheter aortic valve implantation
TA
transapical
TF
transfemoral

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Disclosures: Authors have nothing to disclose with regard to commercial support.