Transapical Transcatheter Aortic Valve Implantation One Year Follow-Up in 19 Patients
Jian Ye, Anson Cheung, John G. Webb, Daniel R. Wong, Ronald G. Carere, Christopher R. Thompson, Samuel V. Lichtenstein; Surgery, University of British Columbia, Vancouver, BC, Canada
Comment on this Abstract
Objective: Added life expectancy has caused a growing elderly population often presenting with aortic stenosis(AS). Elderly patients are not referred/declined for conventional aortic valve replacement(AVR) due to age and/or significant co-morbidities. Transcatheter aortic valve implantation(AVI) without cardiopulmonary bypass could become an alternative treatment for patients who are at too high a risk for AVR.
Methods: Between 2005-2006, 19 patients (11 male) underwent transapical transcatheter AVI with 23 or 26mm Edwards transcatheter aortic bioprostheses through a left mini-thoracotomy. Mean follow-up was 8.8±7.4 months. These patients were non-candidates for transfemoral AVI because of diseased and/or small ilio-femoral arteries, or had failed the transfemoral approach. Clinical & Echo follow-up was performed at discharge, at 1 & 6 months, & then yearly after the procedure. We used matched data from 12 patients who survived over 12 months for comparisons of preoperative baseline, 1-, 6-, & 12-month follow-up Echo results.
Results: Mean age was 79±10yrs & the predicted operative mortality by Logistic EuroScore was 34±21%. Valves were successfully deployed & well seated in the aortic annulus in 18 patients. In 1 patient, a second valve was implanted at the same time. Five patients died within 30 days from pneumonia, sepsis, ischemic bowel, & possible left main obstruction by a displaced native calcified valve. 30-day mortality was 26%. Two patients died from non-cardiovascular diseases after 30 days. Overall 12-month survival was 63%(12). If patients survived 30 days postoperatively, 12-month survival was 86%. There were no late valve-related complications. NYHA class decreased significantly in all patients during follow-up. Aortic valve area (AVA) & mean gradient (MG) of the aortic bioprostheses remain stable at 1-, 6- & 12-month follow-up (AVA: 1.7±0.4, 1.6±0.4, & 1.6±0.4 cm2; MG: 8.5±4.0, 8.7±4.8, & 9.5±5.0 mm Hg, respectively). Trivial-mild paravalvular leaks were common & remain unchanged during the follow-up. Left ventricular ejection fraction improved from 53.3±13.4% preoperatively to 54.5±9.6%, 60.0±9.3%, & 61.8±10.2% at 1-, 6- & 12-month follow-up, respectively.
Conclusion: Pre-existing comorbidity & postoperative sepsis are the main causes of early mortality. Transapical AVI improves quality of life by eliminating cardiac symptoms in most patients, and valve- or cardiovascular-related late mortality or morbidity is rare.
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