Abstract 2534: Early Outcome of Transapical Aortic Valve Implantation Without Cardiopulmonary Bypass Using the Ascendra ™ Valve Delivery System
Background: Aortic valve replacement with cardiopulmonary bypass is associated with significant operative morbidity and mortality in the elderly and patients with significant co-morbidities. Arterial access remains a challenge in elderly patients for percutaneous aortic valve implantation (AVI). We are reporting initial outcome of a new minimally invasive AVI for aortic stenosis (AS) via the apex of the left ventricle (LV) and small left thoracotomy without cardiopulmonary bypass.
Methods: Ten patients (78 ± 11 years old) with end-stage AS and significant co-morbidities, who were deemed to be non-surgical candidates for open-heart aortic valve replacement (AVR) and had no femoral arterial access for percutaneous AVI, underwent off-pump transapical AVI through a small (~5 cm) left anterior thoracotomy. Fluoroscopy and transesophageal echocardiography were used for positioning of the valve at the aortic annulus. Rapid (160 –200 beats/minutes) ventricular pacing was used to decrease forward flow during balloon valvuloplasty and deployment of a 23 or 26 mm Cribier-Edwards™ valve (Edwards Lifesciences Inc., Irvine, CA) through the apex of the LV [Video]. Single lung ventilation was not required during the procedure.
Results: Valves were successfully deployed and well seated in the aortic annulus in all 10 patients. Aortic valve area increased from 0.60 ± 0.14 to 1.83 ± 0.68 cm2 and mean gradient decreased from 38.7 ± 12.7 to 10.2 ± 5.8 mmHg at one month follow-up. No and mild aortic regurgitation was observed in 6 and 4 patients, respectively. There was no perioperative mortality or complication. Thirty-day mortality is 10%. One patient (90 years old) died at day 12 due to pneumonia.
Conclusion: Early outcome of the first series of ten off-pump transapical AVI is excellent. Transapical AVI is safe, feasible and a viable, evolving surgical approach for treatment of AS. Excellent hemodynamic results can be achieved. With advancements in technology, surgical technique, patient selection and proven durability, we believe that indications for transapical AVI will offer a viable alterative for some patients.