Document Detail

Transapical aortic valve implantation: therapy of choice for patients with aortic stenosis and porcelain aorta?
MedLine Citation:
PMID:  20971240     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Conventional aortic valve replacement can be technically challenging in patients with porcelain aorta and is associated with a high rate of stroke and mortality. Porcelain aorta is even sometimes seen as contraindication for surgery. Minimally invasive off-pump transapical aortic valve implantation may be an optimal strategy to treat elderly patients with porcelain aorta requiring aortic valve replacement. METHODS: Twenty-nine patients with severe aortic stenosis and porcelain aorta underwent transapical aortic valve implantation. Mean age was 79 ± 7.8 years (range, 64 to 93 years), with 65.5% female. Logistic EuroSCORE and the Society of Thoracic Surgeons score were 37.7% ± 18.1% and 12.8% ± 2.2%, respectively. Peripheral vascular disease (41.4%) and carotid artery stenosis (58.6%) were frequent, and 17.2% of patients had experienced a stroke previously. The majority of patients were redo cases (51.2%), and 10.3% were dependent on chronic hemodialysis. In 13.8% of all patients, intraoperatively detected porcelain aorta caused an attempt at conventional aortic valve replacement by means of sternotomy to be aborted. RESULTS: All valves were implanted successfully without embolization or aortic dissection. All procedures were primarily performed off-pump, but 4 patients required secondary cardiopulmonary bypass as a result of complications. Median procedure time was 80 minutes, and median intensive care unit stay was 1 day. Stroke occurred in 1 patient only. Thirty-day mortality was 17.2%. Mild paravalvular leak was seen in 31.0%, and mild to moderate regurgitation occurred in 1 patient. CONCLUSIONS: Transapical aortic valve implantation is a promising approach to treat elderly patients with porcelain aorta requiring aortic valve replacement. It is associated with acceptable outcome and low stroke rates.
Jörg Kempfert; Arnaud Van Linden; Axel Linke; Gerhard Schuler; Ardawan Rastan; Sven Lehmann; Lucas Lehmkuhl; Friedrich-Wilhelm Mohr; Thomas Walther
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:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1457-61     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Clinic for Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
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MeSH Terms
Aged, 80 and over
Aortic Diseases / surgery*
Aortic Valve / surgery*
Aortic Valve Stenosis / surgery*
Calcinosis / surgery*
Heart Valve Prosthesis Implantation / methods*
Middle Aged
Comment In:
Ann Thorac Surg. 2010 Nov;90(5):1461-2   [PMID:  20971241 ]

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

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