Abstract 17042: Transapical Aortic Valve Implantation: Analysis of Risk Factors and Learning Experience in 299 Patients
Background: Transapical aortic valve implantation (TA-AVI) has evolved as an established therapeutic option for high risk patients with aortic stenosis. We performed multivariate analysis of outcome related risk factors and evaluated our learning experience over four years.
Methods: 299 patients who received TA-AVI from 02/2006 until 01/2010 using the Edwards SAPIEN™ transcatheter xenograft were analyzed according to early experience (EE = patient 1–150) and recent experience (RE = patient 151–299). Average patient age was 82 ±6 years. RE patients had a significantly higher logistic EuroSCORE predicted risk of mortality than EE patients (34 ±18% vs 29 ±13%, p = 0.01) but a lower STS predicted mortality risk (10 ±6% vs 14 ±8%, p < 0.001). Other perioperative parameters were comparable between the two groups.
Results: Complications such as conversion to full sternotomy, coronary ischemia, need to implant a second prosthesis or annular perforation occurred throughout the study. Two patients (both RE) suffered perioperative stroke. Overall survival at 30 days was significantly better in RE patients (94% vs 86%, p = 0.03).Survival at one year was 67% (EE) versus 75% (RE), p = 0.057 by log-rank. ;multivariate logistic regression analysis revealed severely reduced vital capacity, preoperative significant mitral regurgitation and preoperative chronic dialysis as independent predictors for an increased 30-day mortality.
Conclusions: Outcomes of TA-AVI in high risk patients progressively improved between the early and recent experience in parallel to technical refinements. Despite this preoperative comorbidities and especially reduced pulmonary function have a significant impact on adverse outcomes.
- © 2010 by American Heart Association, Inc.