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J Thorac Cardiovasc Surg 2010;140:e32-e34
© 2010 The American Association for Thoracic Surgery

Brief Clinical Report

Feasibility of transapical aortic valve implantation guided by intracardiac ultrasound without angiography

^a Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
^b Department of Cardiac Anaesthesia, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
^c Paediatric Cardiology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

Received for publication August 28, 2009; accepted for publication January 1, 2010.

^_* Address for reprints: Enrico Ferrari, MD, Department of Cardiovascular Surgery, Centre Hôpitalier Universitaire Vaudois (CHUV), 46, rue du Bugnon, CH-1011 Lausanne, Switzerland. (Email: enricoferrari@bluewin.ch).

The first 20% of the full text of this article appears below.

	Introduction

 
Transcatheter aortic valve implantation (TAVI) is indicated for high-risk patients requiring aortic valve replacement. Valve positioning and postoperative control traditionally are based on intraoperative transesophageal echocardiogram (TEE) and aortography.^1,2 We report, for the first time in humans, a transapical TAVI performed using an intracardiac echocardiogram (ICE) without angiography.

	Clinical Summary

 
A 78-year-old man with symptomatic aortic stenosis was evaluated for TAVI. Concomitant comorbidities were coronary artery sclerosis, peripheral vascular disease, bilateral carotid stenosis, and pulmonary hypertension (50 mm Hg). He also had alcohol-related liver cirrhosis (Child score A) complicated by grade 2 esophageal varices (treated with propranolol) and a platelet count chronically less than 80 x 10³/dL. The echocardiogram showed severe aortic stenosis (orifice area, 0.55 cm²) with transvalvular peak and mean gradients of 68 mm Hg and 38 mm Hg, respectively, moderate left ventricular hypertrophy, and preserved function (left ventricular ejection fraction, 60%). The logistic EuroSCORE was 18%. However, the EuroSCORE does not take into consideration the liver cirrhosis, which is an important risk factor negatively influencing the outcome of high-risk patients undergoing standard cardiac surgery. Therefore, we offered the . . . [Full Text of this Article]