Background: Open-heart Aortic valve replacement (AVR) is associated with significant operative morbidity and mortality in patients with co-morbidities. We report early outcome of a new minimally invasive aortic valve implantation (AVI) via left ventricular apical puncture without cardiopulmonary bypass in initial 20 patients.
Methods: Twenty patients(79±10 years old) with symptomatic aortic stenosis were deemed to be non-surgical candidates for AVR and not suitable for transfemoral procedure due to aortoiliac disease. The predicted 30-day mortality was 35 according to logistic Euroscore. These patients underwent transapical AVI via a left anterior mini-thoracotomy. With the guidance of fluoroscopy and transesophageal echocardiography, balloon valvuloplasty and then deployment of a 23 or 26mm stented bioprosthetic valves were successfully performed using rapid ventricular pacing to reduce forward flow.
Results: Valve implantation was successful in all patients. In one patient there was malposition of the valve and required a second valve placed inside the first valve slightly superiorly with successful results. 14 and 7 of 20 patients had one and six month follow-up echocardiograms respectively that revealed an increase in aortic valve area from 0.6±0.2 to 1.7±0.4 (1 month) and 1.7±0.5 (6 month) cm² and a decrease in the mean gradient from 39±12 to 8±4 (1 month) and 10±6 (6 month) mmHg. None or Trivial, mild and moderate aortic regurgitation was observed in 13, 4 and 2 patient, respectively. There was 5 death in the 30 day perioperative perioid due to aspiration pneumonia, bleeding from chest tube trauma, ischaemic bowel and septic shock. No valve-related complications were observed during the follow-up.
Conclusion: Transapical AVI is a feasible and viable alterative for the patients who are not candidates for open-heart AVR. Early outcomes of transapical AVI are encouraging.