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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Transapical aortic valve implantation - The Leipzig experience.
David M Holzhey1, Martin Hänsig, Thomas Walther
1Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Annals of Cardiothoracic Surgery
|August 27, 2013
Summary
Transcatheter aortic valve implantation (taTAVI) is a safe and effective treatment for severe aortic stenosis in high-risk patients. This five-year review shows reproducible results and highlights the importance of addressing the learning curve for complication reduction.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Transcatheter aortic valve implantation (TAVI) offers a significant advancement for high-risk patients with aortic stenosis.
- This study reviews a five-year experience with transapical TAVI (taTAVI), a pioneering approach at the Leipzig Heart Center.
Purpose of the Study:
- To evaluate the safety, efficacy, and outcomes of transapical TAVI (taTAVI) over a five-year period.
- To analyze the learning curve associated with the taTAVI procedure.
Main Methods:
- Retrospective analysis of 439 patients who underwent taTAVI with an Edwards Sapien valve (2006-2011).
- Data collected from a prospective database and analyzed using descriptive statistics and CUSUM failure analysis.
- Outcomes assessed according to Valve Academic Research Consortium (VARC) criteria.
Main Results:
- Procedural success rate was 90.2% in elderly patients (mean age 81.5 years) with high surgical risk (logistic EuroSCORE 29.7%).
- Key complications included stroke (4.2% total) and moderate-to-greater aortic insufficiency (5.7%).
- Five-year survival rates demonstrated a progressive decline, reaching 44% at 5 years. CUSUM analysis indicated a learning curve effect, with improved outcomes after approximately 150 cases.
Conclusions:
- Transapical TAVI is a routine and safe procedure for high-risk patients with symptomatic severe aortic stenosis, yielding reproducible results.
- Further research is needed to minimize known complications and reduce the learning curve associated with taTAVI.
