Thomas Walther, Volkmar Falk, Michael A. Borger, Jörg Kempfert, Jens Fassl, Yvonne Rückert, Axel Linke, Gerhard Schuler, Friedrich W. Mohr.
Herzzentrum Leipzig, Leipzig, Germany.
Background: To evaluate the results of minimally invasive transapical aortic valve implantation (TA-AVI).
Methods: 94 high risk patients with symptomatic aortic valve stenosis received TAP-AVI using a pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN™) since 02/2006. All valves were implanted in a hybrid operative theatre under fluoroscopic and echocardiographic guidance. Patient age was 83 ±5 years, 76% were female, NYHA class was 3.4 ±0.5, previous cardiac surgery had been performed in 17 patients, logistic EuroSCORE risk for mortality was 29 ±11% and STS score risk for mortality was 16 ±9%.
Results: TA-AVI was performed successfully in 90 (96%) of the patients; four patients required early conversion, two of them were discharged alive. 76% of the patients were treated completely off-pump, secondary use of cardiopulmonary bypass was required in 12 (12.7%) patients. 80% of the patients were extubated early. Echocardiography revealed good valve function; trivial to mild (1°), paravalvular incompetence was present in 40%. At thirty days 9 patients and during follow-up 13 patients (14%) died, all with good valve function at most recent echo. Thirty day survival was 90 ±3%, six months survival 75 ±5% and one year survival 71 ±6%, respectively. There were no new onset neurological events.
Conclusions: Transapical aortic valve implantation is a safe, minimally invasive and off-pump technique to treat high risk patients with aortic stenosis. Results are good at one year, especially when considering the overall risk profile of these patients.
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