Transapical Aortic Valve Implantation in 175 Consecutive Patients: Excellent Outcome in Very High-Risk Patients

• Published in: Journal of the American College of Cardiology 2010-08, Vol.56 (10), p.813-820
• Main Authors: PASIC, Miralem, UNBEHAUN, Axel, DREYSSE, Stephan, DREWS, Thorsten, BUZ, Semih, KUKUCKA, Marian, MLADENOW, Alexander, GROMANN, Tom, HETZER, Roland
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Valve - surgery; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Biological and medical sciences; Body mass index; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Chronic obstructive pulmonary disease; Confidence intervals; Coronary vessels; Diabetes; Echocardiography; Female; Heart Valve Prosthesis Implantation - education; Heart Valve Prosthesis Implantation - methods; Humans; Intraoperative Period; Male; Medical imaging; Medical personnel; Medical sciences; Middle Aged; Mortality; Ostomy; Postoperative Complications; Prostheses; Prosthesis Design; Pulmonary hypertension; Shock, Cardiogenic - complications; Surgery; Surgical techniques; Treatment Outcome; Ultrasonic imaging
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2010.02.065

The aim of this study was to evaluate the outcome of transapical aortic valve implantation in a single center with expanded procedural experience and to compare it with predicted risk for conventional aortic valve surgery. Transapical aortic valve implantation is a new approach for high-risk patients with severe aortic stenosis. There are only limited single-center experiences with very small numbers of patients. Since April 2008, transapical aortic valve implantation was performed in 175 consecutive patients. The mean patient age was 79.8 +/- 9 years, with a range of 36 to 97 years. The mean Society of Thoracic Surgeons score was 23.5 +/- 19.4% (range 2.7% to 89.5%); 98.3% of patients were in New York Heart Association functional class III or IV. Ten patients were in cardiogenic shock. Technical success of the procedure was 100%. There was no conversion to conventional surgery. Cardiopulmonary bypass was used in 8 patients (6 elective, 2 emergency). The 30-day mortality was 5.1% for the entire group, 3.6% for all patients without cardiogenic shock, and 30% for the patients with cardiogenic shock. Survival at 1, 6, and 12 months was 94.9%, 85.5%, and 82.6%, respectively. The outcome of transapical aortic valve implantation was very favorable and already reproducible during the learning curve. The method has become de facto our institutional primary choice for treatment of high-risk patients with severe aortic valve stenosis.