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Thomas Walther
Volkmar Falk
Michael A. Borger
Todd Dewey
Gerhard Wimmer-Greinecker
Gerhard Schuler
Michael Mack
Friedrich W. Mohr
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Eur J Cardiothorac Surg 2007;31:9-15. doi:10.1016/j.ejcts.2006.10.034
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Minimally invasive transapical beating heart aortic valve implantation — proof of concept

Thomas Walthera,*, Volkmar Falka, Michael A. Borgera, Todd Deweyb, Gerhard Wimmer-Greineckerc, Gerhard Schulerd, Michael Mackb, Friedrich W. Mohra

a Department of Cardiac Surgery, Heartcenter, University Leipzig, Leipzig, Germany
b Department of Cardiac Surgery, Cardiopulmonary Research Science and Technology Institute, Dallas, TX, USA
c Department of Thoracic and Cardiovascular Surgery, JW-Goethe University, Frankfurt, Germany
d Department of Cardiology, Heartcenter, University Leipzig, Leipzig, Germany

Received 13 October 2006; received in revised form 29 October 2006; accepted 30 October 2006.

* Corresponding author. Address: Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstr. 39, 04289 Leipzig, Germany. Tel.: +49 341 865 1424; fax: +49 341 865 1452. (Email: walt{at}medizin.uni-leipzig.de).

Objective: To evaluate the feasibility of minimally invasive transapical beating heart aortic valve implantation (TAP-AVI) for high-risk patients with aortic stenosis. Methods: TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Cribier-Edwards, Edwards Lifesciences, Irvine, CA, USA) was used. Thirty consecutive patients (82 ± 5.1 years, 21 (70%) female) were operated from 02/06 until 09/06 at one center using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27 ± 12%. Results: Valve positioning was successful in 29 patients and one required early conversion to full sternotomy. Implantation (8 mm x 23 mm and 22 mm x 26 mm valves) was performed on the beating heart during brief periods of rapid ventricular pacing. ECC was applied in 13 patients. Neither coronary artery obstruction nor migration of the prosthesis was observed and all valves displayed good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 14 patients (trace in three, mild in nine and moderate in two). Three patients (10%) died, one on postoperative day (POD) three secondary to preoperative global myocardial failure and two on POD 18 and 86 due to abdominal complications. Conclusions: Minimally invasive beating heart TAP-AVI is feasible. Initial results are encouraging in view of the high-risk profile of the patients. Long-term studies as well as randomized protocols are required.

Key Words: Aortic valve replacement • Transapical aortic valve implantation • Minimally invasive cardiac surgery • Beating heart cardiac surgery • Transcatheter valve implantation




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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.