Transapical aortic valve implantation in 100 consecutive patients: comparison to propensity-matched conventional aortic valve replacement

• Published in: European heart journal 2010-06, Vol.31 (11), p.1398-1403
• Main Authors: Walther, Thomas, Schuler, Gerhard, Borger, Michael A., Kempfert, Jörg, Seeburger, Jörg, Rückert, Yvonne, Ender, Jörg, Linke, Axel, Scholz, Markus, Falk, Volkmar, Mohr, Friedrich W.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic valve replacement; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiology. Vascular system; Endocardial and cardiac valvular diseases; Female; Heart; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Postoperative Care; Preoperative Care; Propensity Score; Retrospective Studies; Risk Factors; Transapical aortic valve implantation; Transcatheter; Transplantation, Heterologous; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehq060

Aims To evaluate the outcome of transapical aortic valve implantation (TA-AVI) in comparison to conventional surgery. Methods and results One hundred consecutive high-risk patients with symptomatic aortic valve stenosis received TA-AVI using the Edwards SAPIEN™ pericardial xenograft between February 2006 and January 2008. Patient age was 82.7 ± 5 years, 77 were females, logistic EuroSCORE predicted risk of mortality was 29.4 ± 13% and Society Thoracic Surgeons score risk for mortality was 15.2 ± 8.3%. Propensity score analysis was used to identify a control group of patients that underwent conventional aortic valve replacement (C-AVR). Transapical aortic valve implantation was performed successfully in 97 patients, whereas three patients required early conversion. There were no new onset neurological events in the TA-AVI group and early extubation was performed in 82 patients. Echocardiography revealed good valve function with low transvalvular gradients in all patients. Thirty-day survival was 90 ± 3 vs. 85 ± 4% for TA-AVI vs. C-AVR, and 1-year survival was 73 ± 4 vs. 69 ± 5% (P = 0.55). Conclusion Transapical aortic valve implantation is a safe, minimally invasive, and off-pump technique to treat high-risk patients with aortic stenosis. Results of the initial 100 patients are good and compare favourably to conventional surgery.