Document Detail


Transapical aortic valve implantation in 194 patients: problems, complications, and solutions.
MedLine Citation:
PMID:  20971242     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transapical aortic valve implantation is a novel approach for high-risk patients with severe aortic stenosis. During our learning curve, we were faced with several problems, technical difficulties, and complications, and our strategy and procedural technique evolved accordingly. We report our experience during the learning curve for establishing this new method.
METHODS: Between April 2008 and January 2010, 194 patients (mean age, 80 ± 9 years; range, 36 to 99 years) were treated by transapical aortic valve implantation. The mean Society of Thoracic Surgeons score was 23.5% ± 19.4% (range, 2.7% to 89.5%; logistic EuroSCORE, 41% ± 20%; range, 6% to 97%). We have established institutional guidelines on how to act in particular situations, with regard to patient selection, procedural steps, and complications concerning the procedure that have evolved according to our own experience. Mandatory angiographic visualization of the aortic root during valve deployment was introduced, combined with slow and gradual inflation of the balloon with possible correction of the valve position and its definitive position higher than we had been taught.
RESULTS: Technical success was 99.5% with one conversion to conventional surgery (annulus rupture). One intraprocedural obstruction of the left coronary ostium was successfully treated by emergency stent implantation. The 30-day mortality was 5.7% for the whole group (11 of 194 patients), 3.8% for all patients without cardiogenic shock (7 of 182 patients), and 33% for the patients with cardiogenic shock (4 of 12 patients). There were 2 (1%) new clinical neurologic events postoperatively.
CONCLUSIONS: A combination of patient-related evaluation and several small but precise technical modifications of the original transapical aortic valve implantation techniques reduced the rate of complications and increased success during the learning curve.
Authors:
Miralem Pasic; Semih Buz; Stephan Dreysse; Thorsten Drews; Axel Unbehaun; Christoph Klein; Marian Kukucka; Alexander Mladenow; Ekaterina Ivanitskaia-Kühn; Roland Hetzer
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2010-11-10     Revised Date:  2011-10-05    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1463-9; discussion 1469-70     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Deutsches Herzzentrum Berlin, Berlin, Germany. pasic@dhzb.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aneurysm, False / etiology
Aortic Valve / surgery*
Coronary Stenosis / etiology
Echocardiography
Echocardiography, Transesophageal
Heart Valve Prosthesis Implantation / adverse effects*
Hemodynamics
Humans
Middle Aged
Patient Selection
Postoperative Complications / etiology
Comments/Corrections
Comment In:
Ann Thorac Surg. 2011 Sep;92(3):1157-8   [PMID:  21871335 ]

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