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Results of percutaneous and transapical transcatheter aortic valve implantation performed by a surgical team

Clinic for Cardiovascular Surgery, German Heart Center Munich, Lazarettstr. 36, 80636 Munich, Germany

Received 29 August 2008; received in revised form 10 December 2008; accepted 18 December 2008.

^_* Corresponding author. Tel.: +49 89 1218 1522; fax: +49 89 1218 4093. (Email: bleiziffer{at}dhm.mhn.de).

Objective: Transcatheter aortic valve implantation has been performed by several groups, most of them either specializing on the transapical (surgeons) or the percutaneous femoral transarterial approach (cardiologists). We achieved both transapical and percutaneous transcatheter valve implantation by a surgical team in a hybrid suite. Methods: Since June 2007, 137 patients (n = 78 female, mean age 81 ± 7 years) underwent transcatheter aortic valve implantation (n = 109 transfemoral, n = 3 via subclavian artery, n = 2 directly through ascending aorta, n = 23 transapical) with the CoreValve (n = 114) or the Edwards Sapien (n = 23) prosthesis. Results: Thirty-day mortality was 12.4% in this patient cohort. One hundred and eight patients (78.8%) are alive at a mean follow-up of 97 ± 82 days. Pacemaker implantation due to postoperative AV block was performed in 27 patients (19.7%), and 7 patients (5.1%) sustained neurological events. Patients improved in NYHA class (from 3.1 ± 0.3 to 1.9 ± 0.5, p < 0.001) and in self-assessed health state (from 55 ± 17% to 68 ± 16%, p < 0.001) at one-month follow-up. Echocardiographic assessment revealed excellent hemodynamic function of the prostheses with a mean aortic gradient (MAG) of 11.9 ± 4.4 mmHg and an effective orifice area (EOA) of 1.6 ± 0.4 cm² at discharge and a MAG of 11.0 ± 4.2 mmHg and an EOA of 1.6 ± 0.3 cm² at six months FU. Conclusions: Transcatheter aortic valve implantation has become an alternative technique for the treatment of aortic stenosis with reasonable short- and mid-term results at our institution. With the opportunity to treat aortic stenosis by conventional surgical valve replacement and transapical and percutaneous transcatheter procedures, the technique of lowest risk for the individual patient can be chosen and performed by one team.

Key Words: Valves • Aortic stenosis • Minimally invasive • Interventional

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