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Transapical aortic valve implantation in patients requiring redo surgery

^a Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstr 39, 04289 Leipzig, Germany
^b Universität Leipzig, Herzzentrum, Klinik für Anaesthesie, Strümpellstr 39, 04289 Leipzig, Germany
^c Universität Leipzig, Herzzentrum, Klinik für Kardiologie, Strümpellstr 39, 04289 Leipzig, Germany

Received 7 September 2008; received in revised form 31 January 2009; accepted 4 February 2009.

^_* Corresponding author. Tel.: +49 341 865 1424; fax: +49 341 865 1452. (Email: walt{at}medizin.uni-leipzig.de).

Objective: To evaluate the results of minimally invasive transapical aortic valve implantation (TA-AVI) in patients requiring redo surgery. Methods: Twenty-five high risk patients with symptomatic aortic valve stenosis and previous cardiac surgical interventions received TA-AVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN^TM) since February 2006. All valves were implanted in a hybrid operative theater. Patient age was 78 years, 60% were female, logistic EuroSCORE and STS score risk for mortality were 39% and 17%, respectively. Previous cardiac surgery was CABG in 17, valve surgery in 5 and other in 3 patients. Results: TA-AVI was performed successfully in 24 (96%) of the patients. One patient required early conversion to sternotomy and one patient required temporary ECMO support. A total of 21 patients (84%) were treated completely off-pump, one early patient was treated on-pump by intention and three patients required secondary cardiopulmonary bypass support. Echocardiography revealed good valve function in all but the converted patient, with trivial to mild (1°) paravalvular incompetence in 40%. Three patients died within 30 days of the procedure and during follow-up four patients died, all with good valve function at most recent echo. Thirty-day survival was 88% and one-year survival was 72%. There were no new-onset neurological events. Conclusions: TA-AVI can be performed with excellent results and minimal stroke risk in high risk patients requiring redo cardiac surgery. TA-AVI represents an important alternative to conventional surgery in elderly high risk patients requiring reoperative procedures.

Key Words: Aortic valve implantation • Reoperation • Transapical

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