Transapical aortic valve implantation in 175 consecutive patients: excellent outcome in very high-risk patients.

OBJECTIVES

The aim of this study was to evaluate the outcome of transapical aortic valve implantation in a single center with expanded procedural experience and to compare it with predicted risk for conventional aortic valve surgery.

BACKGROUND

Transapical aortic valve implantation is a new approach for high-risk patients with severe aortic stenosis. There are only limited single-center experiences with very small numbers of patients.

METHODS

Since April 2008, transapical aortic valve implantation was performed in 175 consecutive patients. The mean patient age was 79.8 +/- 9 years, with a range of 36 to 97 years. The mean Society of Thoracic Surgeons score was 23.5 +/- 19.4% (range 2.7% to 89.5%); 98.3% of patients were in New York Heart Association functional class III or IV. Ten patients were in cardiogenic shock.

RESULTS

Technical success of the procedure was 100%. There was no conversion to conventional surgery. Cardiopulmonary bypass was used in 8 patients (6 elective, 2 emergency). The 30-day mortality was 5.1% for the entire group, 3.6% for all patients without cardiogenic shock, and 30% for the patients with cardiogenic shock. Survival at 1, 6, and 12 months was 94.9%, 85.5%, and 82.6%, respectively.

CONCLUSIONS

The outcome of transapical aortic valve implantation was very favorable and already reproducible during the learning curve. The method has become de facto our institutional primary choice for treatment of high-risk patients with severe aortic valve stenosis.