Abstract 2466: Transapical Aortic Valve Implantation At One Year
Objective: To evaluate the results of minimally invasive transapical aortic valve implantation (TAP-AVI) at one year follow-up.
Methods: 61 high risk patients with symptomatic aortic valve stenosis received TAP-AVI at our institution since 02/2006. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN™ THV, Edwards Lifesciences, Irvine, CA, USA) was used. All valves were implanted in a hybrid operative theatre under fluoroscopic and echocardiographic guidance. Patient age was 82.7 ±4.5 years, 79% were female, NYHA class was 3.4 ±0.5, previous cardiac surgery had been performed in eight patients, logistic EuroSCORE risk for mortality was 28.1 ±11.9% and STS score risk for mortality was 15.9 ±8.6%.
Results: TAP-AVI was performed successfully in 58 (95.1%) of the patients; three patients required early conversion due to proximal dislocation, secondary dissection of the aortic root and main stem occlusion. Two of the converted patients were discharged alive. A total of 73.7% of the patients were treated completely off-pump, secondary use of cardiopulmonary bypass was required in 3/39 (7.8%). 82% of the patients were extubated early after 80 ±17min. Echocardiography revealed good valve function; trivial to mild (1°), paravalvular incompetence was present in 41%. At thirty days four (6.6%) patients and during follow-up eight patients (15.3%) died, all with good valve function at most recent echo. Thirty day survival was 93 ±3.4%, six months survival 74.4 ±6.6% and one year survival 70.5 ±7.3%, respectively. There were no neurological events.
Conclusions: Transapical aortic valve implantation is a safe, minimally invasive and off-pump technique to treat high risk patients with aortic stenosis. One year results are good, especially when considering the overall risk profile of these patients.