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Published on: May 21, 2017
Trans-apical aortic valve implantation in patients with severe calcification of the ascending aorta
Semih Buz1, Miralem Pasic, Axel Unbehaun
1Deutsches Herzzentrum Berlin, Berlin, Germany.
Insights
Trans-apical aortic valve implantation is a safe procedure for patients with severe ascending aorta calcification. This minimally invasive approach offers good survival rates and low stroke risk in this high-risk group.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- High stroke and mortality rates are associated with conventional aortic valve replacement in patients with ascending aorta calcification.
- The outcomes of trans-apical aortic valve implantation (TAAVI) in this specific patient group are not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of TAAVI using the Edwards Sapien valve in patients with severe ascending aorta calcification.
- To assess procedural success, complications, and survival rates in this high-risk population.
Main Methods:
- A single-center retrospective analysis of 258 patients undergoing TAAVI between April 2008 and July 2010.
- Identification of 46 patients (18%) with severe ascending aorta calcification (including porcelain aorta) via computed tomography (CT) scan.
- Detailed assessment of procedural outcomes, including valve function, neurological events, and survival.
Main Results:
- Successful primary valve implantation in 44 out of 46 patients; two required a second valve (valve-in-valve).
- No 30-day mortality observed. Postoperative stroke occurred in 6.2% of patients, with only 2.1% experiencing neurological deficit.
- Six-month and 12-month survival rates were 88% and 85.2%, respectively. Mild valve incompetence and paravalvular leak were observed in 37% and 32.6% of patients.
Conclusions:
- Trans-apical aortic valve implantation is a safe and feasible option for patients with aortic valve stenosis and severe ascending aorta calcification.
- TAAVI demonstrates acceptable procedural outcomes and survival rates in this challenging patient cohort.
Objective:
In patients with calcification of the ascending aorta, postoperative stroke and mortality rates remain high after conventional aortic valve replacement, but the results of trans-apical aortic valve implantation in these patients are not known. We evaluate the outcome of trans-apical aortic valve implantation in patients with severely calcified ascending aorta in a single center with expanded procedural experience.
Methods:
Between April 2008 and July 2010, 258 patients underwent trans-apical aortic valve implantation using Edwards Sapien valve. By computed tomography (CT) scan, we identified 46 (18%) patients with severe calcification of the ascending aorta (16 with porcelain aorta and 30 with severe, but not complete, calcification).
Results:
Of 46 patients (mean age 77 ± 10 years, range 63-90 years; EuroSCORE (European System for Cardiac Operative Risk Evaluation) 45 ± 22%; STS (Society of Thoracic Surgeons) score 23 ± 13) with calcified aorta, 15 received 23-mm valves and 31 patients 26-mm valves. Primary valve implantation was successful in 44 patients and a second valve was implanted (valve-in-valve) in two. Six patients underwent concomitant interventions (three elective percutaneous coronary intervention (PCI), one off-pump coronary artery bypass (OPCAB), one tricuspid valve reconstruction, and one left-ventricular (LV) aneurysmectomy). The final procedural results showed valve incompetence (trace or grade 1) in 17 (37%) patients and paravalvular leak in 15 (32.6%) (trace in 10 and grade 1 in five). There was no 30-day mortality. Postoperatively, cranial CT showed new cerebral ischemia areas in three patients (6.2%), but only one patient (2.1%) experienced postoperative neurological deficit (temporary aphasia). Survival at 6 and 12 months was 88% and 85.2%, respectively.
Conclusions:
Trans-apical aortic valve implantation can be performed safely in patients with aortic valve stenosis and severe calcification of the ascending aorta.
