HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gerhard Wimmer-Greinecker Sven Martens Anton Moritz Mirko Doss Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zierer, A. Articles by Doss, M. Search for Related Content PubMed Articles by Zierer, A. Articles by Doss, M. Related Collections Minimally invasive surgery Valve disease

J Thorac Cardiovasc Surg 2008;136:948-953
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

The transapical approach for aortic valve implantation

^a Division of Cardiothoracic Surgery, Hospital of the Johann Wolfgang Goethe University, Frankfurt/Main, Germany

Received for publication April 1, 2008; revisions received May 18, 2008; accepted for publication June 15, 2008.

^_* Address for reprints: Mirko Doss, MD, Division of Cardiothoracic Surgery, Hospital of the Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. (Email: mirko.doss{at}kgu.de).

Objective: Percutaneous aortic valve implantation has been performed clinically in high-risk patients with severe aortic stenosis. Transfemoral retrograde valve delivery is limited by concomitant peripheral vascular disease and the size of the delivery system. We report on the alternative transapical approach that allows accurate antegrade placement of a catheter-deliverable aortic valve.

Methods: Over a 2-year period, 26 consecutive patients (84.3 ± 6.5 years) were treated at our center. Transapical aortic valve implantation was performed with 23-mm and 26-mm pericardial valves (Cribier–Edwards; Edwards Lifesciences, Irvine, Calif) mounted on a stainless steel stent. A limited anterolateral incision, in the fifth intercostal space, was used to access the apex of the heart. The valve was crimped, placed into a 24F sheath, and introduced into the left ventricle through purse-string sutures. Fluoroscopy and transesophageal echocardiography were used to guide the catheter across the native valve and to direct deployment of the stent at the level of the annulus. During deployment, the heart was unloaded with extracorporeal support or with rapid ventricular pacing. The average logistic EuroSCORE-predicted risk for mortality was 36.5% ± 5.8%.

Results: All valves were successfully deployed at the target. On echocardiography, all valves showed good hemodynamic function with only minor paravalvular leakages. The mean transaortic valve gradient was 6 ± 2 mm Hg. Thirty-day mortality was 15% (n = 4). One patient died of perforation of the right ventricle and 1 of dissection of the aortic root. There were 2 cases of conversion to open surgery. In 2 patients, the left main stem was partially obstructed by the native valve and required stent angioplasty.

Conclusions: Initial results of the transapical approach are encouraging. Long-term studies and randomized protocols will be required to further evaluate this procedure.

This article has been cited by other articles:

				S. Bleiziffer, D. Mazzitelli, A. Opitz, I. Hettich, H. Ruge, N. Piazza, and R. Lange Beyond the short-term: Clinical outcome and valve performance 2 years after transcatheter aortic valve implantation in 227 patients J. Thorac. Cardiovasc. Surg., February 1, 2012; 143(2): 310 - 317. [Abstract] [Full Text] [PDF]

				R. G. Seipelt, G.-G. Hanekop, F. A. Schoendube, and W. Schillinger Heart team approach for transcatheter aortic valve implantation procedures complicated by coronary artery occlusion Interact CardioVasc Thorac Surg, January 9, 2012; (2012) ivr136v1. [Abstract] [Full Text] [PDF]

				K. Bijuklic, T. Tuebler, H. Reichenspurner, H. Treede, A. Wandler, J. H. Harreld, R. I. Low, and J. Schofer Midterm Stability and Hemodynamic Performance of a Transfemorally Implantable Nonmetallic, Retrievable, and Repositionable Aortic Valve in Patients With Severe Aortic Stenosis: Up to 2-Year Follow-Up of the Direct-Flow Medical Valve: A Pilot Study Circ Cardiovasc Interv, December 1, 2011; 4(6): 595 - 601. [Abstract] [Full Text] [PDF]

				R. Lange, S. Bleiziffer, N. Piazza, D. Mazzitelli, A. Hutter, P. Tassani-Prell, J.-C. Laborde, and R. Bauernschmitt Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients Eur J Cardiothorac Surg, November 1, 2011; 40(5): 1105 - 1113. [Abstract] [Full Text] [PDF]

				T. Modine, J. F. Obadia, E. Choukroun, G. Rioufoul, A. Sudre, J. C. Laborde, and P. Leprince Transcutaneous aortic valve implantation using the axillary/subclavian access: Feasibility and early clinical outcomes J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 487 - 491.e1. [Abstract] [Full Text] [PDF]

				S. Geisbusch, S. Bleiziffer, D. Mazzitelli, H. Ruge, R. Bauernschmitt, and R. Lange Incidence and Management of CoreValve Dislocation During Transcatheter Aortic Valve Implantation Circ Cardiovasc Interv, December 1, 2010; 3(6): 531 - 536. [Abstract] [Full Text] [PDF]

				T. Modine, G. Lemesle, R. Azzaoui, and A. Sudre Aortic valve implantation with the CoreValve ReValving System via left carotid artery access: First case report J. Thorac. Cardiovasc. Surg., October 1, 2010; 140(4): 928 - 929. [Full Text] [PDF]

				R. R. Coeytaux, J. W. Williams Jr., R. N. Gray, and A. Wang Percutaneous Heart Valve Replacement for Aortic Stenosis: State of the Evidence Ann Intern Med, September 7, 2010; 153(5): 314 - 324. [Abstract] [Full Text] [PDF]

				E. Ferrari, C. Sulzer, C. Marcucci, E. Rizzo, P. Tozzi, and L. K. von Segesser Transapical Aortic Valve Implantation Without Angiography: Proof of Concept Ann. Thorac. Surg., June 1, 2010; 89(6): 1925 - 1932. [Abstract] [Full Text] [PDF]

				T. D. Yan, C. Cao, J. Martens-Nielsen, R. Padang, M. Ng, M. P. Vallely, and P. G. Bannon Transcatheter aortic valve implantation for high-risk patients with severe aortic stenosis: A systematic review J. Thorac. Cardiovasc. Surg., June 1, 2010; 139(6): 1519 - 1528. [Abstract] [Full Text] [PDF]

				A. L. Bartorelli, D. Andreini, E. Sisillo, G. Tamborini, M. Fusari, and P. Biglioli Left Main Coronary Artery Occlusion After Percutaneous Aortic Valve Implantation Ann. Thorac. Surg., March 1, 2010; 89(3): 953 - 955. [Abstract] [Full Text] [PDF]

				A. Zierer, G. Wimmer-Greinecker, S. Martens, A. Moritz, and M. Doss Is transapical aortic valve implantation really less invasive than minimally invasive aortic valve replacement? J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1067 - 1072. [Abstract] [Full Text] [PDF]

				S. Bleiziffer, H. Ruge, D. Mazzitelli, A. Hutter, A. Opitz, R. Bauernschmitt, and R. Lange Survival after transapical and transfemoral aortic valve implantation: Talking about two different patient populations J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1073 - 1080. [Abstract] [Full Text] [PDF]

				N. Al-Attar, W. Ghodbane, D. Himbert, C. Rau, R. Raffoul, D. Messika-Zeitoun, E. Brochet, A. Vahanian, and P. Nataf Unexpected Complications of Transapical Aortic Valve Implantation Ann. Thorac. Surg., July 1, 2009; 88(1): 90 - 94. [Abstract] [Full Text] [PDF]