067-ITREATMENT OF AORTIC VALVE STENOSIS: FIVE YEARS OF EXPERIENCE WITH AN INTEGRATED 360° APPROACH IN A HIGH-VOLUME CENTRE

• Published in: Interactive cardiovascular and thoracic surgery 2014-10, Vol.19 (suppl_1), p.S20-S20
• Main Authors: Wilbring, M., Taut, T., Ibrahim, K., Matschke, K., Kappert, U.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.67

Objectives: The present study evaluated results of an integrative approach for treatment of symptomatic aortic stenosis patients at almost every surgical risk, considering all available surgical and catheter-based techniques. Methods: Since 2008, an interdisciplinary heart team, considering available treatment strategies and devices on an equal footing, made all decisions. Clinical results were recorded and compared. Results: A total of 2569 patients with isolated aortic stenosis were enrolled. The majority of 1954 patients underwent surgical aortic valve replacement (SAVR). The remaining 615 patients were treated with transcatheter aortic valve implantation (TAVI), 386 using the transapical (TA) and 229 the transfemoral (TF) approach. The percentage of TAVI increased from 2.5% in 2008 to 43.8% of all isolated AVR in 2012. This trend was particularly true for patients >80 years (12.5% to 93.9%). The clinical success of TAVI encouraged further expansion, including re-operative surgery (n = 53), and surgery for failed aortic/mitral valve bioprosthesis as well as failed mitral repair (n = 20 and n = 4, respectively). Familiarisation with the transapical approach allowed antegrade endovascular treatment of aortic disease (n = 4). Risk-adjusted hospital mortality was comparable for SAVR (3.1%), TA-TAVI (5.5%) and TF-TAVI (5.5%). TF-TAVI was associated with higher incidence of combined morbidity including one of the following: major access complications, renal failure, major bleeding, myocardial infarction, permanent pacemaker implant or stroke (49.5% vs 24.0% in TA-TAVI and 9.9% in SAVR). Conclusion: The “One Heart–One Team” approach, offering all treatment strategies, techniques and devices, allows a tailor-made, patient-orientated surgery and is of utmost importance for offering an individualised treatment option for almost every patient in almost every risk constellation.