Transapical aortic valve implantation in patients requiring redo surgery

To evaluate the results of minimally invasive transapical aortic valve implantation (TA-AVI) in patients requiring redo surgery.

Twenty-five high risk patients with symptomatic aortic valve stenosis and previous cardiac surgical interventions received TA-AVI using a pericardial xenograft fixed within a stainless steel, balloon-expandable stent (Edwards SAPIEN) since February 2006. All valves were implanted in a hybrid operative theater. Patient age was 78 years, 60% were female, logistic EuroSCORE and STS score risk for mortality were 39% and 17%, respectively. Previous cardiac surgery was CABG in 17, valve surgery in 5 and other in 3 patients.

TA-AVI was performed successfully in 24 (96%) of the patients. One patient required early conversion to sternotomy and one patient required temporary ECMO support. A total of 21 patients (84%) were treated completely off-pump, one early patient was treated on-pump by intention and three patients required secondary cardiopulmonary bypass support. Echocardiography revealed good valve function in all but the converted patient, with trivial to mild (1 degrees) paravalvular incompetence in 40%. Three patients died within 30 days of the procedure and during follow-up four patients died, all with good valve function at most recent echo. Thirty-day survival was 88% and one-year survival was 72%. There were no new-onset neurological events.

TA-AVI can be performed with excellent results and minimal stroke risk in high risk patients requiring redo cardiac surgery. TA-AVI represents an important alternative to conventional surgery in elderly high risk patients requiring reoperative procedures.