Abstract 18331: Transcatheter Aortic Valve Implantation: Results with Noncompetitive Decision Making for Transfemoral or Transapical Approach
Objectives: To evaluate outcome of a strategy using a noncompetitive decision making for transfemoral or transapical aortic valve implantation (AVI) in high risk preoperative profile patients with symptomatic aortic stenosis.
Methods: Since 8/2008, 122 patients were consecutively treated with transcatheter AVI because of high surgical risk or contraindication to surgery. Decision making for transfemoral or transapical approach followed an interdisciplinary consensus by a heart team weighing the individual risk profile including vascular, pulmonary and morphological pathology. Mean patient age was 83.3 ± 4.3 years, 69% were female, and mean ejection fraction 49%. Previous cardiac surgery was apparent in twenty-one patients (17%). Mean logistic EuroSCORE and STS Score were 28.4% and 12.1%. Fifty-two patients (43%) were treated with transfemoral (34 Sapien, 18 Corevalve), and 69 (57%) with transapical (all Sapien) approach.
Results: Procedural survival was 99%, with successful implantation in 121/122 patients. No conversion to open heart surgery was necessary. Operative (30-day) mortality was 7.4%. Overall mortality fell from 11.5% in the initial half to 3.3% in the second half of the experience, while risk profile of the patients remained comparable (logistic EuroSCORE 27.9% vs. 28.9%). Due to migration of the valve one valve-in-valve implantation was successfully performed. Three patients (2.5%) required secondary cardiopulmonary support. Vascular complications occurred in 12% of transfemoral patients. Three patients suffered a transient neurological event and 8 patients required pacemaker. Echocardiography revealed good valve function in all patients with mild insufficiency in 12%. Survival at 1 year was 85%.
Conclusion: With an interdisciplinary approach evaluating in a noncompetitive way individually transfemoral and transapical techniques, transcatheter AVI represents an important alternative to conventional surgery in high risk patients resulting in good immediate and one year outcome.
- © 2010 by American Heart Association, Inc.