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Eur J Cardiothorac Surg 2007;31:16-21. doi:10.1016/j.ejcts.2006.10.023
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients

Divisions of Cardiac Surgery and Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada

Received 31 August 2006; received in revised form 3 October 2006; accepted 6 October 2006.

^_* Corresponding authors. Address: Division of Cardiothoracic Surgery, St. Paul's Hospital, Room 489, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Tel.: +1 604 806 9349; fax: +1 604 806 8375. (Email: jye{at}providencehealth.bc.ca; svlichtenstein{at}providencehealth.bc.ca).

Background: The current treatment of choice for symptomatic aortic stenosis is aortic valve replacement (AVR) with cardiopulmonary bypass (CPB), but AVR is associated with significant operative morbidity and mortality in elderly patients with multiple co-morbid conditions. We recently reported the first successful aortic valve implantation procedure (AVI) via a mini-thoracotomy and left ventricular apical puncture without cardiopulmonary bypass. We now report 6-month follow-up in our initial seven patients. Methods: Seven patients (77 ± 10 years old) with symptomatic aortic stenosis were deemed to be non-surgical candidates for AVR and not suitable for a transfemoral percutaneous heart valve implantation due to aorto-iliac disease. The predicted 30-day operative mortality was 31 ± 23% according to logistic Euroscore. Patients underwent minimally invasive transapical AVI. With the guidance of fluoroscopy and transesophageal echocardiography, balloon predilation was followed by deployment of a 26 mm Cribier–Edwards^TM valve (Edwards Lifesciences Inc., Irvine, CA) during rapid ventricular pacing to reduce forward flow and cardiac motion. Results: Valve implantation was successful in all seven patients. There were no intra-procedural mortalities or complications. Thirty-day operative mortality was 14%. One patient died at day 12 due to pneumonia. Two patients died from non-cardiac diseases at day 51 and 85. The remaining four patients completed 6-month follow-up. The aortic valve area increased from 0.7 ± 0.3 to 1.8 ± 0.7 and 1.5 ± 0.5 cm² at 1 and 6 months, respectively. The mean transaortic gradient was reduced from 32 ± 8 to 10 ± 5 and 11 ± 8 mmHg at 1 and 6 months, respectively. Following AVI, none or trivial, mild, and moderate aortic regurgitation was observed in 4, 2, and 1 patients, respectively. There were no valve-related complications during the follow-up. Conclusion: Aortic valve implantation can successfully be performed via a minimally invasive apical approach without the need for cardiopulmonary bypass. The early results in this initial series are encouraging. This initial experience suggests that the minimally invasive transapical approach is a viable alternative for patients in whom open-heart surgery is not feasible or poses unacceptable risks.

Key Words: Aorta • Catheter • Stenosis • Valves • Valvuloplasty

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