141MINI-THORACOTOMY DIRECT AORTIC SELF-EXPANDING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SINGLE-CENTRE EXPERIENCE

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_2; pp. S103 - S104
• Main Authors: Bruschi, G., Botta, L., De Marco, F., Colombo, P., Barosi, A., Mondino, M., Klugmann, S., Martinelli, L.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt372.141

Objectives: Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery; however these patients are also often affected by severe iliac-femoral arteriopathy, rendering the transfemoral approach unemployable. Methods: From May 2008 to March 2013, two-hundred patients (105 female, mean age 81.5 ± 9.7 years) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk, were eligible for a TAVI. Forty-five patients (all affected by severe peripheral vasculopathy, including eight redo procedures, nine patients with prior stroke, 31 patients affected by severe renal failure, mean EuroSCORE II 14.4 ± 12.4%, STS mortality score 12.6 ± 7.7%) underwent CoreValve implantation directly from the ascending aorta through a right anterior mini-thoracotomy. A combined team of cardiologists, cardiac surgeons with expertize in hybrid procedures, and anaesthetists performed all the procedures. Results: In all patients, after valve deployment the mean aortic gradient immediately dropped to ≤5 mmHg; 41 patients had angiographic grade aortic insufficiency ≤1. One case was converted to a transfemoral approach due to an extremely fragile aortic wall, but the patient died due to abdominal aorta aneurysm rupture on postoperative day 1. Procedural success was obtained in all other (44) cases; one patient experienced left ventricle tear, successfully surgically treated; seven patients (19%) required a permanent pacemaker implantation; 30-day mortality was 6.6% (three patients), with a cardiac cause in two patients (4.4%). All discharged patients improved their NYHA functional class and functional capacity and echocardiograms demonstrated good valve performance up to two years, mean valve gradient 9 mmHg. Four patients died during follow-up due to cachexia and bone marrow aplasia, acute myocardial infarction and severe renal failure. Conclusions: Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new, attractive option for treating selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a redo procedure.