Leontyev S. , Holzhey D. , Mohr F.
Heart Center Leipzig;Objective:
The aim was analyzed the results of transapical aortic valve implantation in high-risk patients with aortic stenosis at up to 5 years after the procedure.
A total of 439 patients underwent transapical aortic valve implantation fr om February 2006 until August 2011 using the Edwards SAPIENTM prosthesis. Mean patient age was 81 ± 6 years and 64% were female. Logistic EuroSCORE and STS predicted risks for mortality were 30% ± 16% and 11% ± 8%, respectively. All patients were treated in a hybrid suite with advanced imaging modalities by a specialized transcatheter aortic valve implantation (TAVI) team.
30 day mortality was 9.6 %. Major vascular complications (3.4%), life-threatening or disabling bleeding (6.2%), and acute kidney injury using a modified RIFLE classification (stage 1: 8.3%, stage 2: 3.3% and stage 3: 16.3%) were further major adverse events.
Periprocedural stroke/TIA rate was in 2.1% directly postoperative and in 2.1% of patients during their hospital stay. Transapical aortic valve implantation was uneventful in 384 patients, whereas 55 patients (12.5%) required additional interventions. Such interventions included cardiopulmonary bypass support in 6.2%, implantation of a second SAPIEN valve in 5.5%, coronary intervention in 3.0%, conversion to conventional surgery in 2.5%, and annulus perforation in 0.7% patients (not mutually exclusive). Overall survival was 90% at 30 days, 73% at 1 year, 68% at 2 years, 58% at 3 years, 53% at 4 years and 44% at 5 years.
Transapical aortic valve implantation can be performed with good early and long-term outcomes in high-risk patients with severe aortic stenosis. Perioperative complications occur in approximately 12.5% of patients.