Abstract 4790: Transcatheter Off-pump Aortic Valve Implantation In Patients With Very High Risk For Conventional Aortic Valve Replacement
Objectives–Transcatheter aortic valve implantation (TAVI) has been suggested as an endovascular alternative to conventional aortic valve replacement in selected high-risk patients. We sought to determine, whether TAVI is also feasible as a reasonable treatment option in patients with a very or extremely high risk for conventional aortic valve replacement, presenting a logistic EuroSCORE >30% and/or STS-score >15%.
Methods and Results–Between 05/2005 and 05/2008, twenty-five (81.3±4.2 years, 17 female) out of a total of 50 TAVI patients with severe and symptomatic aortic stenosis underwent either transfemoral (n=10) or transapical (n=15) off-pump aortic valve implantation. All patients were rejected for conventional aortic valve replacement with an average EuroSCORE of 45±13% and a STSscore of 15±4%. Valve implantation was performed in a hybrid operative theatre using the Edwards SAPIEN™ prosthesis (Edwards-Lifesciences). All valve implantations (23mm valves in 9 and 26mm valves in 16 patients) were successful, and there was no coronary artery obstruction or migration of the prosthesis. Intraoperatively, after valve insertion, significant hemodynamic improvement could be measured in left ventricular ejection fraction (P<0.001) and cardiac index (P<0.001), whereas mean aortic pressure gradients decreased significantly from 43±21 before to 7±5 mmHg (P<0.001), associated with an increase in echocardiographic valve area from 0.76±0.24 to 2.1±0.6 cm2 (P<0.001). Operative mortality was 4% (1/25) and mortality at 30 days 24% (6/25). Actuarial survival was 72% at a follow-up of 239±260 (mean±SD) days. Echocardiography revealed paravalvular leakage in 8 patients during hospital stay (trace in 3, mild in 4, and severe in 1 patients) and in 6 patients at follow-up (trace in 4, mild in 2), but no structural valve deterioration could be observed.
Conclusions–Transcatheter off-pump aortic valve implantation in patients with severe aortic stenosis and a very or extremely high-risk for conventional aortic valve replacement, estimated by Euro-/STS-score, is feasible and may be a reasonable treatment option in these patients.