Abstract 3344: Transapical Minimally Invasive Aortic Valve Implantation
Objective To evaluate the initial results with minimally invasive transapical placement (TAP) of an aortic valve xenograft for high risk patients with aortic stenosis.
Methods TAP was performed via a small anterolateral minithoracotomy with or without femoro-femoral extracor-poreal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Cribier-Edwards Ascendra™, Edwards Lifesciences, Irvine, CA, USA) was used. 34 consecutive patients (81 ±5.2 years, 26 (76.5%) female) were operated since 02/2006 at two centers using fluoroscopic and echocardiographic visualization. Average EuroScore predicted risk for mortality was 26±13%.
Results TAP valve positioning was performed successfully in 31 patients, 3 required early conversion. Implantation (23mm valves in 13 and 26mm valves in 21 patients) was performed on the beating heart during brief periods of rapid ventricular pacing. ECC was applied in 16 patients. In the 31 patients neither coronary artery obstruction nor migration of the prosthesis was observed, all had good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 16 patients (mild in 12 and trace in 4). Five patients (14.7%) died, two on POD 2 due to stroke and cardiac arrest, one on POD 50 due to cardiac arrest and two on POD 18 and 86 due to abdominal complications.
Conclusions TAP of a stent delivered aortic valve prosthesis 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.