Transapical aortic valve implantation: The Vancouver experience

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology

Background:

• Transapical aortic valve implantation (TA-TAVI) using mini-thoracotomy was first performed in Vancouver in 2005.
• This study details the Vancouver experience with 178 TA-TAVI cases in patients with symptomatic severe aortic stenosis (AS).

Purpose of the Study:

• To describe the Vancouver experience with transapical aortic valve implantation (TA-TAVI) in 178 patients with symptomatic severe aortic stenosis (AS).
• To evaluate the outcomes and long-term survival of TA-TAVI in this cohort.

Main Methods:

• Retrospective analysis of 178 TA-TAVI cases performed between October 2005 and March 2012.
• Comparison of baseline characteristics and in-hospital outcomes between early and late cohorts.
• Echocardiographic assessment of valve function and Kaplan-Meier analysis for 3-year survival, stratified by STS score.

Main Results:

• Mean patient age was 80.5 years; 6.2% experienced intra-operative complications.
• In-hospital survival was 87.9%, with a stroke incidence of 3.4%.
• Significant improvements in aortic valve area and transvalvular gradient were observed post-procedure and maintained at 3-year follow-up. Overall 3-year survival was 47.3%, with improved survival in lower-risk patients (Log-rank P=0.039).

Conclusions:

• Transapical aortic valve implantation (TA-TAVI) is a reasonable therapeutic option for symptomatic severe AS patients at high risk for conventional AVR.
• The procedure is associated with acceptable risks and demonstrates sustained hemodynamic improvement.
• Long-term survival is superior in lower-risk patients undergoing TA-TAVI.