Document Detail


Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients.
MedLine Citation:
PMID:  17126558     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The current treatment of choice for symptomatic aortic stenosis is aortic valve replacement (AVR) with cardiopulmonary bypass (CPB), but AVR is associated with significant operative morbidity and mortality in elderly patients with multiple co-morbid conditions. We recently reported the first successful aortic valve implantation procedure (AVI) via a mini-thoracotomy and left ventricular apical puncture without cardiopulmonary bypass. We now report 6-month follow-up in our initial seven patients. METHODS: Seven patients (77+/-10 years old) with symptomatic aortic stenosis were deemed to be non-surgical candidates for AVR and not suitable for a transfemoral percutaneous heart valve implantation due to aorto-iliac disease. The predicted 30-day operative mortality was 31+/-23% according to logistic Euroscore. Patients underwent minimally invasive transapical AVI. With the guidance of fluoroscopy and transesophageal echocardiography, balloon predilation was followed by deployment of a 26mm Cribier-Edwardstrade mark valve (Edwards Lifesciences Inc., Irvine, CA) during rapid ventricular pacing to reduce forward flow and cardiac motion. RESULTS: Valve implantation was successful in all seven patients. There were no intra-procedural mortalities or complications. Thirty-day operative mortality was 14%. One patient died at day 12 due to pneumonia. Two patients died from non-cardiac diseases at day 51 and 85. The remaining four patients completed 6-month follow-up. The aortic valve area increased from 0.7+/-0.3 to 1.8+/-0.7 and 1.5+/-0.5cm(2) at 1 and 6 months, respectively. The mean transaortic gradient was reduced from 32+/-8 to 10+/-5 and 11+/-8mmHg at 1 and 6 months, respectively. Following AVI, none or trivial, mild, and moderate aortic regurgitation was observed in 4, 2, and 1 patients, respectively. There were no valve-related complications during the follow-up. CONCLUSION: Aortic valve implantation can successfully be performed via a minimally invasive apical approach without the need for cardiopulmonary bypass. The early results in this initial series are encouraging. This initial experience suggests that the minimally invasive transapical approach is a viable alternative for patients in whom open-heart surgery is not feasible or poses unacceptable risks.
Authors:
Jian Ye; Anson Cheung; Samuel V Lichtenstein; Sanjeevan Pasupati; Ronald G Carere; Christopher R Thompson; Ajay Sinhal; John G Webb
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2006-11-28
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  31     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-15     Completed Date:  2007-03-30     Revised Date:  2007-10-02    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  16-21     Citation Subset:  IM    
Affiliation:
Divisions of Cardiac Surgery and Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. jye@providencehealth.bc.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Aortic Valve / surgery,  ultrasonography
Aortic Valve Stenosis / surgery*
Aortography
Cardiopulmonary Bypass / contraindications
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / methods*
Humans
Male
Middle Aged
Prosthesis Design
Surgical Procedures, Minimally Invasive / methods*
Treatment Outcome
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2007 Jan;31(1):7-8   [PMID:  17140803 ]
Eur J Cardiothorac Surg. 2007 Jan;31(1):4-6   [PMID:  17113304 ]
Eur J Cardiothorac Surg. 2007 Jul;32(1):188; author reply 188-90   [PMID:  17459718 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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