This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 114/6/591    most recent CIRCULATIONAHA.106.632927v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lichtenstein, S. V. Articles by Webb, J. G. Search for Related Content PubMed PubMed Citation Articles by Lichtenstein, S. V. Articles by Webb, J. G. Related Collections Congestive Valvular heart disease Catheter-based coronary and valvular interventions: other CV surgery: valvular disease Related Article

(Circulation. 2006;114:591-596.)
© 2006 American Heart Association, Inc.

Valvular Heart Disease

Transapical Transcatheter Aortic Valve Implantation in Humans

Initial Clinical Experience

Samuel V. Lichtenstein, MD, PhD; Anson Cheung, MD; Jian Ye, MD; Christopher R. Thompson, MD; Ronald G. Carere, MD; Sanjeevan Pasupati, MD; John G. Webb, MD

From the Divisions of Cardiology and Cardiac Surgery, St Paul’s Hospital, University of British Columbia, Vancouver, Canada.

Correspondence to John G. Webb, MD, Director, Interventional Cardiology, St. Paul’s Hospital, Room 5202A, 1081 Burrard St, Vancouver, BC, Canada V6Z 2E8. E-mail webb{at}providencehealth.bc.ca

Received April 14, 2006; revision received May 22, 2006; accepted May 30, 2006.

Background— Aortic valve replacement with cardiopulmonary bypass is currently the treatment of choice for symptomatic aortic stenosis but carries a significant risk of morbidity and mortality, particularly in patients with comorbidities. Recently, percutaneous transfemoral aortic valve implantation has been proposed as a viable alternative in selected patients. We describe our experience with a new, minimally invasive, catheter-based approach to aortic valve implantation via left ventricular apical puncture without cardiopulmonary bypass or sternotomy.

Methods and Results— A left anterolateral intercostal incision is used to expose the left ventricular apex. Direct needle puncture of the apex allows introduction of a hemostatic sheath into the left ventricle. The valve prosthesis, constructed from a stainless steel stent with an attached trileaflet equine pericardial valve, is crimped onto a valvuloplasty balloon. The prosthetic valve and balloon catheter are passed over a wire into the left ventricle. Positioning within the aortic annulus is confirmed by fluoroscopy, aortography, and echocardiography. Rapid ventricular pacing is used to reduce cardiac output while the balloon is inflated, deploying the prosthesis within the annulus. Transapical aortic valve implantation was successfully performed in 7 patients in whom surgical risk was deemed excessive because of comorbidities. Echocardiographic median aortic valve area increased from 0.7±0.1 cm² (interquartile range) to 1.8±0.8 cm² (interquartile range). There were no intraprocedural deaths. At a follow up of 87±56 days, 6 of 7 patients remain alive and well.

Conclusions— This initial experience suggests that transapical aortic valve implantation without cardiopulmonary bypass is feasible in selected patients with aortic stenosis.

---

 

CLINICAL PERSPECTIVE

Related Article:

Issue Highlights
Circulation 2006 114: 529. [Full Text]

This article has been cited by other articles:

				A. Vahanian, O. R. Alfieri, N. Al-Attar, M. J. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 1 - 8. [Abstract] [Full Text] [PDF]

				L. G. Svensson, T. Dewey, S. Kapadia, E. E. Roselli, A. Stewart, M. Williams, W. N. Anderson, D. Brown, M. Leon, B. Lytle, et al. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann. Thorac. Surg., July 1, 2008; 86(1): 46 - 55. [Abstract] [Full Text] [PDF]

				N. V. Vasilyev, P. M. Novotny, J. F. Martinez, H. Loyola, I. S. Salgo, R. D. Howe, and P. J. del Nido Stereoscopic vision display technology in real-time three-dimensional echocardiography-guided intracardiac beating-heart surgery. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1334 - 1341. [Abstract] [Full Text] [PDF]

				F. Descoutures, D. Himbert, L. Lepage, B. Iung, D. Detaint, D. Tchetche, E. Brochet, Y. Castier, J.-P. Depoix, P. Nataf, et al. Contemporary surgical or percutaneous management of severe aortic stenosis in the elderly Eur. Heart J., June 1, 2008; 29(11): 1410 - 1417. [Abstract] [Full Text] [PDF]

				A. Vahanian, O. Alfieri, N. Al-Attar, M. Antunes, J. Bax, B. Cormier, A. Cribier, P. De Jaegere, G. Fournial, A. P. Kappetein, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur. Heart J., June 1, 2008; 29(11): 1463 - 1470. [Abstract] [Full Text] [PDF]

				A. Sinhal, L. Altwegg, S. Pasupati, K. H. Humphries, M. Allard, P. Martin, A. Cheung, J. Ye, C. Kerr, S. V. Lichtenstein, et al. Atrioventricular Block After Transcatheter Balloon Expandable Aortic Valve Implantation J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 305 - 309. [Abstract] [Full Text] [PDF]

				J. G. Webb Percutaneous Aortic Valve Replacement Will Become a Common Treatment for Aortic Valve Disease J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 122 - 126. [Abstract] [Full Text] [PDF]

				T. K. Rosengart, T. Feldman, M. A. Borger, T. A. Vassiliades Jr, A. M. Gillinov, K. J. Hoercher, A. Vahanian, R. O. Bonow, and W. O'Neill Percutaneous and Minimally Invasive Valve Procedures: A Scientific Statement From the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group Circulation, April 1, 2008; 117(13): 1750 - 1767. [Abstract] [Full Text] [PDF]

				N. V. Vasilyev, I. Melnychenko, K. Kitahori, F. P. Freudenthal, A. Phillips, R. Kozlik-Feldmann, I. S. Salgo, P. J. del Nido, and E. A. Bacha Beating-heart patch closure of muscular ventricular septal defects under real-time three-dimensional echocardiographic guidance: A preclinical study J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 603 - 609. [Abstract] [Full Text] [PDF]

				S. H. Rahimtoola The Year in Valvular Heart Disease. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]

				M. J. Davidson and D. S. Baim Percutaneous Aortic Valve Interventions Card. Surg. Adult, January 1, 2008; 3(2008): 963 - 971. [Full Text]

				T. Feldman and M. B. Leon Prospects for Percutaneous Valve Therapies Circulation, December 11, 2007; 116(24): 2866 - 2877. [Full Text] [PDF]

				E. Berreklouw, B. Vogel, H. Fischer, F. Weinberg, G. L. van Rijk-Zwikker, G. J. Van Nooten, and L. H. Cohn Fast sutureless implantation of mechanical aortic valve prostheses using Nitinol attachment rings: Feasibility in acute pig experiments. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1508 - 1512. [Abstract] [Full Text] [PDF]

				B. Marcheix, Y. Lamarche, C. Berry, A. Asgar, J.-C. Laborde, A. Basmadjian, A. Ducharme, A. Denault, R. Bonan, and R. Cartier Surgical aspects of endovascular retrograde implantation of the aortic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis. J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1150 - 1156. [Abstract] [Full Text] [PDF]

				T. Walther, P. Simon, T. Dewey, G. Wimmer-Greinecker, V. Falk, M. T. Kasimir, M. Doss, M. A. Borger, G. Schuler, D. Glogar, et al. Transapical Minimally Invasive Aortic Valve Implantation: Multicenter Experience Circulation, September 11, 2007; 116(11_suppl): I-240 - I-245. [Abstract] [Full Text] [PDF]

				E. M. Flecher, J. W. Curry, T. M. Joudinaud, C. L. Kegel, P. A. Weber, and C. M.G. Duran Coronary flow obstruction in percutaneous aortic valve replacement. An in vitro study Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 291 - 294. [Abstract] [Full Text] [PDF]

				S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., July 17, 2007; 50(3): 270 - 285. [Full Text] [PDF]

				E. Grube, G. Schuler, L. Buellesfeld, U. Gerckens, A. Linke, P. Wenaweser, B. Sauren, F.-W. Mohr, T. Walther, B. Zickmann, et al. Percutaneous Aortic Valve Replacement for Severe Aortic Stenosis in High-Risk Patients Using the Second- and Current Third-Generation Self-Expanding CoreValve Prosthesis: Device Success and 30-Day Clinical Outcome J. Am. Coll. Cardiol., July 3, 2007; 50(1): 69 - 76. [Abstract] [Full Text] [PDF]

				T. Walther, V. Falk, T. Dewey, J. Kempfert, F. Emrich, B. Pfannmuller, P. Broske, M. A. Borger, G. Schuler, M. Mack, et al. Valve-in-a-Valve Concept for Transcatheter Minimally Invasive Repeat Xenograft Implantation J. Am. Coll. Cardiol., July 3, 2007; 50(1): 56 - 60. [Abstract] [Full Text] [PDF]

				E. Grube, L. Buellesfeld, U. Gerckens, R. Mueller, M. Menichelli, T. Schmidt, J. C. Laborde, T. Felderhoff, S. Iversen, B. Sauren, et al. Response to Letter Regarding Article, "Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease: The Siegburg First-in-Man Study" Circulation, June 5, 2007; 115(22): e613 - e613. [Full Text] [PDF]

				M. J. Antunes Off-pump aortic valve replacement with catheter-mounted valved stents.: Is the future already here? Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 1 - 3. [Full Text] [PDF]

				T. Walther and F. W. Mohr Aortic valve surgery: time to be open-minded and to rethink Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 4 - 6. [Full Text] [PDF]

				F. Beyersdorf Transapical transcatheter aortic valve implantation Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 7 - 8. [Full Text] [PDF]

				T. Walther, V. Falk, M. A. Borger, T. Dewey, G. Wimmer-Greinecker, G. Schuler, M. Mack, and F. W. Mohr Minimally invasive transapical beating heart aortic valve implantation -- proof of concept Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 9 - 15. [Abstract] [Full Text] [PDF]

				J. Ye, A. Cheung, S. V. Lichtenstein, S. Pasupati, R. G. Carere, C. R. Thompson, A. Sinhal, and J. G. Webb Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 16 - 21. [Abstract] [Full Text] [PDF]

				C. Schreiber, J. Horer, M. Vogt, S. Fratz, M. Kunze, C. Galm, A. Eicken, and R. Lange A new treatment option for pulmonary valvar insufficiency: first experiences with implantation of a self-expanding stented valve without use of cardiopulmonary bypass Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 26 - 30. [Abstract] [Full Text] [PDF]

				J. D. Carroll The Evolving Treatment of Aortic Stenosis: Do New Procedures Provide New Treatment Options for the Highest-Risk Patients? Circulation, August 8, 2006; 114(6): 533 - 535. [Full Text] [PDF]