Abstract 4789: The Complete Canadian Experience On Transapical Transcatheter Aortic Valve Replacement
Objectives: Conventional aortic valve replacement carries significant risk in patients with multiple comorbidities. Retrograde transcatheter aortic valve replacement (TAVR) via the femoral artery has been shown to be a viable option for some patients. The presence of peripheral vascular disease precludes the transfemoral approach. We have previously reported our transapical TAVR technique our early experience. This report consists of the complete Canadian experience in transapical TAVR.
Methods: The clinical, procedural and follow-up data of all patients that underwent transpical TAVR in Canada were obtained from the prospective registries. All transapical TAVR were carried out under the special access protocol approved by Health Canada and local IRB. All cases were performed via an anterior thoracotomy, valve prosthesis positioning and deployment were aided by fluoroscopy and TEE. The balloon-expandable pericardial valve stents were implanted into all patients.
Results: A total of 88 patients underwent TAVR in Canada from 10/05 to 4/08. Fifty-seven patients (65%) were female and the mean age of patient was 81.5±7.5 years (range 58 to 93). Mean STS and logistic EuroScore were 11.8±7.6% and 33.2±20.2%, respectively. Successful implantation of the valve prosthesis was obtained in 85 patients (97%). Intraoperative malpositioning occurred in 3 patients. One intraoperative death (1.1%) was reported and the overall 30-day mortality was 15%. Mean aortic valve area improved from 0.62±0.19 to 1.52±0.45, 1.53±0.33 and 1.54±0.33 cm2 and mean transvalvular gradient decreased from 41±5.2 to 9.2±3.8, 9.5±3.9 and 9.9±4.7 mmHg at discharge, 6 and 12 months, respectively. Mild or absence of paravalvular leak occurred in most patients and remained stable during the follow-up. Late embolization occurred in 2 patients requiring reoperation in both.
Conclusions: This is the world second largest series of transapical TAVR. Transapical TAVR is feasible and associated with a high success and a relatively low complication rate in very high risk patients. The early and mid-term valve prosthesis hemodynamic performance was excellent. Further follow-up is needed to determine the durability and late hemodynamic performance of this prosthesis.