Document Detail

Results of transfemoral or transapical aortic valve implantation following a uniform assessment in high-risk patients with aortic stenosis.
MedLine Citation:
PMID:  19608027     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to describe the results of a strategy offering either transfemoral or transapical aortic valve implantation in high-risk patients with severe aortic stenosis. BACKGROUND: Results of transfemoral and transapical approaches have been reported separately, but rarely following a uniform assessment to select the procedure. METHODS: Of 160 consecutive patients at high risk or with contraindications to surgery, referred between October 2006 and November 2008, 75 were treated with transcatheter aortic valve implantation. The transfemoral approach was used as the first option and the transapical approach was chosen when contraindications to the former were present. The valve used was the Edwards Lifesciences SAPIEN prosthesis. RESULTS: Patients were age 82 +/- 8 years (mean +/- SD), in New York Heart Association functional classes III/IV, with predicted mean surgical mortalities of 26 +/- 13% using the European System for Cardiac Operative Risk Evaluation and 16 +/- 7% using the Society of Thoracic Surgeons Predicted Risk of Mortality. Fifty-one patients were treated via the transfemoral approach, and 24 via the transapical approach. The valve was implanted in 93% of the patients. Hospital mortality was 10%. Mean (+/- SD) 1-year survivals were 78 +/- 6% in the whole cohort, 81 +/- 7% in the transfemoral group, 74 +/- 9% in the transapical group (p = 0.22), and 60 +/- 10% in the first 25 patients versus 93 +/- 4% in the last 50 patients treated (p = 0.001). In multivariate analysis, early experience was the only significant predictor of late mortality. CONCLUSIONS: Being able to offer either transfemoral or transapical aortic valve implantation, within a uniform assessment, expands the scope of the treatment of aortic stenosis in high-risk patients and provides satisfactory results at 1 year in this population. The results are strongly influenced by experience.
Dominique Himbert; Fleur Descoutures; Nawwar Al-Attar; Bernard Iung; Gregory Ducrocq; Delphine Détaint; Eric Brochet; David Messika-Zeitoun; Fady Francis; Hassan Ibrahim; Patrick Nataf; Alec Vahanian
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  54     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-17     Completed Date:  2009-08-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  303-11     Citation Subset:  AIM; IM    
Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
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MeSH Terms
Aged, 80 and over
Aortic Valve Stenosis / surgery*
Heart Catheterization*
Heart Valve Prosthesis Implantation / methods*
Risk Factors
Treatment Outcome

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