Document Detail


Is transapical aortic valve implantation really less invasive than minimally invasive aortic valve replacement?
MedLine Citation:
PMID:  19740493     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transcatheter valve implants currently draw their justification for use from reduction of perioperative risk. However, patient age and comorbidities are independent predictors of adverse outcome after aortic valve replacement, regardless of surgical approach. Therefore, it is unclear whether transapical aortic valve implantation really improves outcomes in high-risk patients. METHODS: We included a total of 51 high-risk patients with severe aortic valve stenosis. Patients were allocated to transapical aortic valve implantation (n = 21) or minimally invasive aortic valve replacement via a partial upper sternotomy (n = 30), in a nonrandomized fashion. Patient age, preoperative comorbidities, and perioperative risk, expressed as logistic EuroSCORE (38% +/- 14% vs 35% +/- 9%), were matched between the 2 groups. RESULTS: Early morbidity and mortality were comparable between groups, but transapical aortic valve implantation was associated with shorter operative time (P = .004), ventilation time (P < .001), intensive care unit stay (P < .001), and hospital stay (P < .001). Thirty-day mortality was 14% (n = 3) in the transcatheter group versus 10% (n = 3) in the surgical group. After a mean follow-up of 12 +/- 4 months (100% complete), there were a total of 5 (24%) deaths in the transapical group versus 5 (17%) deaths in the open surgery group. There was 1 intraoperative death in the transapical group versus none in the surgery group. In the transapical group, there were 2 re-explorations for bleeding, 2 intraoperative conversions, 1 case of prosthesis migration, and 2 impairments of coronary arteries. The surgery group included 1 re-exploration, 1 stroke, 1 pacemaker implantation for complete atrioventricular block, and 3 cases of atrial fibrillation. CONCLUSIONS: Current data suggest a faster postoperative recovery after transapical aortic valve implantation, with early and late morbidity and mortality comparable with those of minimally invasive aortic valve replacement via partial upper sternotomy.
Authors:
Andreas Zierer; Gerhard Wimmer-Greinecker; Sven Martens; Anton Moritz; Mirko Doss
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Publication Detail:
Type:  Journal Article     Date:  2009-09-09
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  138     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-19     Completed Date:  2009-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1067-72     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, Hospital of the Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt am Main, Germany.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aortic Valve / surgery
Aortic Valve Stenosis / mortality,  surgery*
Comorbidity
Female
Follow-Up Studies
Heart Catheterization*
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / methods*,  mortality
Hospital Mortality
Humans
Length of Stay / statistics & numerical data
Male
Postoperative Complications / mortality
Risk Factors
Surgical Procedures, Minimally Invasive* / mortality
Time Factors
Treatment Outcome

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


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