Transapical Aortic Valve Implantation in 100 Consecutive Patients: Comparison to Propensity-Matched Conventional Aortic Valve Replacement

European Heart Journal. 2010; 32(7):233-242

Thomas Walther, Gerhard Schuler, Michael A. Borger, Jörg Kempfert, Jörg Seeburger, Yvonne Rückert, Jörg Ender, Axel Linke, Markus Scholz, Volkmar Falk, Friedrich W. Mohr

OBJECTIVES: To evaluate the outcome of transapical aortic valve implantation (TA-AVI) in comparison to conventional surgery.

METHODS: One hundred consecutive high-risk patients with symptomatic aortic valve stenosis received TA-AVI using the Edwards SAPIEN™ pericardial xenograft between February 2006 and January 2008. Patient age was 82.7 ± 5 years, 77 were females, logistic EuroSCORE predicted risk of mortality was 29.4 ± 13% and Society Thoracic Surgeons score risk for mortality was 15.2 ± 8.3%. Propensity score analysis was used to identify a control group of patients that underwent conventional aortic valve replacement (C-AVR).

RESULTS: Transapical aortic valve implantation was performed successfully in 97 patients, whereas three patients required early conversion. There were no new onset neurological events in the TA-AVI group and early extubation was performed in 82 patients. Echocardiography revealed good valve function with low transvalvular gradients in all patients. Thirty-day survival was 90 ± 3 vs. 85 ± 4% for TA-AVI vs. C-AVR, and 1-year survival was 73 ± 4 vs. 69 ± 5% (P = 0.55).

CONCLUSIONS: Transapical aortic valve implantation is a safe, minimally invasive, and off-pump technique to treat high-risk patients with aortic stenosis. Results of the initial 100 patients are good and compare favourably to conventional surgery.

PMID: 20233788

2 Responses

  1. Paul Schoenhagen, MD  on March 30th, 2010

    See also post from March 9,2010:

    Transcatheter Aortic Valve Implantation for the Treatment of Severe Symptomatic Aortic Stenosis in Patients at Very High or Prohibitive Surgical Risk: Acute and Late Outcomes of the Multicenter Canadian Experience.
    Josep Rodés-Cabau, John G. Webb, Anson Cheung, Jian Ye, Eric Dumont, Christopher M. Feindel, Mark Osten, Madhu K. Natarajan, Eric Horlick, et al.
    J Am Coll Cardiol. 2010; 55(3):1080-1090.
    PMID: 20096533

  2. Jacobo Kirsch, MD  on April 14th, 2010

    Key finding: There were no new onset neurological events in the TA-AVI group!

    See also:
    Risk and Fate of Cerebral Embolism After Transfemoral Aortic Valve Implantation A Prospective Pilot Study With Diffusion-Weighted Magnetic Resonance Imaging (link)


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