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(Circulation. 2007;116:I-240 – I-245.)
© 2007 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Transapical Minimally Invasive Aortic Valve Implantation

Multicenter Experience

Thomas Walther, MD, PhD; Paul Simon, MD, PhD; Todd Dewey, MD; Gerhard Wimmer-Greinecker, MD, PhD; Volkmar Falk, MD, PhD; Marie T. Kasimir, MD; Mirko Doss, MD; Michael A. Borger, MD, PhD; Gerhard Schuler, MD, PhD; Dietmar Glogar, MD, PhD; Wolfgang Fehske, MD, PhD; Ernst Wolner, MD, PhD; Friedrich W. Mohr, MD, PhD; Michael Mack, MD, PhD

From the University Leipzig, Heartcenter, Departments of Cardiac Surgery (T.W., V.F., M.A.B., F.W.M.) and Cardiology (G.S.), Leipzig, Germany; University Hospital AKH, Departments of Cardiothoracic Surgery (P.S., M.T.K., E.W.) and Cardiology (D.G.), Vienna, Austria; Cardiopulmonary Research Science and Technology Institute, Department of Cardiac Surgery (T.D., M.M.), Dallas, Tex; Department of Thoracic and Cardiovascular Surgery (G.W.-G., M.D.), JW-Goethe University Frankfurt, Germany; and the Department of Cardiology (W.F.), St.-Vinzenz-Hospital, Cologne, Germany.

Correspondence to Prof Dr Thomas Walther, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstrasse 39, 04289 Leipzig, Germany. E-mail walt{at}medizin.uni-leipzig.de

Background— To evaluate initial multicenter results with minimally invasive transapical aortic valve implantation (TAP-AVI) for high risk patients with aortic stenosis.

Methods and Results— TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoro-femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN THV, Edwards Lifesciences) was used. Fifty-nine consecutive patients (81±6 years, 44 female) were operated on from 02/06 until 10/06 at 4 centers using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27±14%. TAP valve positioning was performed successfully in 53 patients, 4 required early conversion to sternotomy. Implantation (23-mm valves in 19 and 26-mm valves in 40 patients) was performed on the beating heart during brief periods of rapid ventricular pacing. Thirty-one patients were operated on without cardiopulmonary bypass. Neither coronary artery obstruction nor migration of the prosthesis was observed, and all valves had good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 26 patients (trace in 11, mild in 12, and severe in 3). Eight patients died in-hospital (13.6%) without any valve dysfunction. Actuarial survival was 75.7±5.9% at a follow-up interval of 110±77 days (range 1 to 255 days).

Conclusions— TAP-AVI can be performed safely with good early results in high risk patients. Long-term valve performance as well as broader based applications of this promising approach will need to be studied.

Key Words: valves • aorta • cardiovascular diseases • stent fixed xenograft • transcatheter techniques