Transapical aortic valve implantation after previous heart surgery

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Transcatheter aortic valve implantation (TAVI) is an emerging treatment for severe aortic stenosis in high-risk patients.
• Patients with prior cardiac surgery present unique challenges and risks for TAVI, including potential graft or prosthesis damage.

Purpose of the Study:

• To evaluate the safety and efficacy of transapical aortic valve implantation (TA-TAVI) in patients with and without previous cardiac surgery.
• To compare procedural outcomes and survival rates between these two patient groups.

Main Methods:

• A consecutive series of 198 patients undergoing TA-TAVI between April 2008 and January 2010.
• Group A: 158 patients without prior heart surgery. Group B: 40 patients with prior heart surgery (including CABG, AVR, MVR).
• Comparison of preoperative risk scores (EuroSCORE, STS), technical success, postoperative gradients, and mortality/survival rates.

Main Results:

• High technical success rates: 99.5% in Group A and 100% in Group B.
• Group B patients were younger but had significantly higher preoperative risk scores.
• 30-day mortality (6.9% vs 5.0%) and 1-year survival (77% vs 74%) were comparable between groups, with no significant difference.

Conclusions:

• Transcatheter valve implantation is feasible and successful in patients with previous heart surgery.
• Careful attention to valve positioning is crucial to avoid damage to existing grafts or prostheses.
• TA-TAVI can be a valuable option for high-risk patients, irrespective of prior cardiac interventions.