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J Thorac Cardiovasc Surg 2009;137:167-173
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Transapical transcatheter aortic valve implantation: 1-year outcome in 26 patients

Jian Ye, MDa,*, Anson Cheung, MDa, Samuel V. Lichtenstein, MD, PhDa, Lukas A. Altwegg, MDb, Daniel R. Wong, MDa, Ronald G. Carere, MDb, Christopher R. Thompson, MDb, Robert R. Moss, MDb, Brad Munt, MDb, Sanjeevan Pasupati, MDb, Robert H. Boone, MDb, Jean-Bernard Masson, MDb, Abdullah Al Ali, MDb, John G. Webb, MDb

a Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
b Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Received for publication May 14, 2008; revisions received July 28, 2008; accepted for publication August 31, 2008.

* Address for reprints: Jian Ye, MD, Division of Cardiothoracic Surgery, St Paul's Hospital, Room 489, 1081 Burrard St, Vancouver, BC, Canada, V6Z 1Y6. (Email: jye{at}providencehealth.bc.ca).

Background: We reported the first case of successful transapical transcatheter aortic valve implantation in a human subject in 2005 and have now completed a 12-month follow-up on our first 26 patients. This is, to date, the longest follow-up of patients undergoing transapical aortic valve implantation.

Methods: Between October 2005 and January 2007, 26 patients (13 female) underwent transcatheter transapical aortic valve implantation with either 23- or 26-mm Edwards Lifesciences transcatheter bioprostheses. All patients with symptomatic aortic stenosis were declined for conventional aortic valve replacement because of unacceptable operative risks and were not candidates for transfemoral aortic valve implantation because of poor arterial access. Clinical and echocardiographic follow-up was performed before discharge and at 1, 6, and 12 months. Data from the 17 patients who survived over 12 months were used for comparisons of the baseline and follow-up results.

Results: The mean age was 80 ± 9 years, and the predicted operative mortality was 37% ± 20% by using logistic EuroSCORE and 11% ± 6% by using the Society of Thoracic Surgeons Risk Calculator. Valves were successfully implanted in all patients. Six patients died within 30 days (30-day mortality, 23%), and 3 patients died from noncardiovascular causes after 30 days (late mortality, 12%). Among patients who survived at least 30 days, 12-month survival was 85%. There were no late valve-related complications. New York Heart Association functional class improved significantly. The aortic valve area and mean gradient remained stable at 12 months (1.6 ± 0.3 cm2 and 9.6 ± 4.8 mm Hg, respectively).

Conclusion: Our 1-year clinical and echocardiographic outcomes suggest that transapical transcatheter aortic valve implantation is a viable alternative to conventional aortic valve replacement in selected high-risk patients.

Abbreviations and Acronyms AVI = aortic valve implantation; AVR = aortic valve replacement; CPB = cardiopulmonary bypass; NYHA = New York Heart Association; STS = Society of Thoracic Surgeons; TEE = transesophageal echocardiography




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