Transapical aortic valve implantation at one year

Aims: To evaluate the results of minimally invasive transapical aortic valve implantation (TAP-AVI) at one year follow-up. Methods: 79 high risk patients with symptomatic aortic valve stenosis received TAP-AVI using a pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN™) since 02/2006. All valves were implanted in a hybrid operative theatre under fluoroscopic and echocardiographic guidance. Patient age was 82.7±4.6 years, 77% were female, NYHA class was 3.4±0.5, previous cardiac surgery had been performed in 14 patients, logistic EuroSCORE risk for mortality was 28.9±13% and STS score risk for mortality was 15.6±9%. Results: TAP-AVI was performed successfully in 76 (96.2%) of the patients; three patients required early conversion, two of them were discharged alive. 75.9% of the patients were treated completely off-pump, secondary use of cardiopulmonary bypass was required in 8 (10.1%) patients. 82% of the patients were extubated early after 80±17min. Echocardiography revealed good valve function; trivial to mild (1°), paravalvular incompetence was present in 42%. At thirty days 6 (7.6%) patients and during follow-up 11 patients (15.1%) died, all with good valve function at most recent echo. Thirty day survival was 92.1±3.1%, six months survival 75.4±5.5% and one year survival 72.9±5.8%, respectively. There were no new onset neurological events. Conclusions: Transapical aortic valve implantation is a safe, minimally invasive and off-pump technique to treat high risk patients with aortic stenosis. One year results are good, especially when considering the overall risk profile of these patients.