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Objective:
The transcatheter aortic valve implantation (TAVI) was developed as an alternative therapeutical approach for high risk patients. This study presents the 4 years results of the first transapical aortic valve implantations performed in Europe.
Methods:
From March 2006 till December 2007, 47 patients, aged 82 +/- 5 years presenting with severe symptomatic aortic valve stenosis underwent a transapical aortic valve implantation at our institution. All patients were rejected for conventional aortic valve replacement. The predicted operative mortality was 26 % by logistic EuroScore and 7 % STS Score. The calculated morbidity was 8.5% by STS Score. Poor (<30%) left ventricular function was observed in 26 % of patients.
Results:
Valve implantation was successful in 42 patients; the remaining 5 patients underwent a conversion to open heart aortic valve replacement. The 30 days and 1 year survival was 83 % and 48 %. After 4 years 38 % are still alive at a mean age of 85 years. From 30 days postoperative to 1 year, 9 patients died of non-cardiac related causes as a consequence of their severe comorbidities. In 40 % of patients with poor ejection fraction, the ventricular function doubled within the first postoperative year. The mean aortic gradient decreased from 58 mmHg preoperatively to 11 mmHg and remained on 14 mmHg. No severe degeneration or dysfunction of the aortic valve could be observed up to 4 years.
Conclusion:TAVI is evolving as a promising option for high risk patients which can result in sustained functional improvement. Interdisciplinary and conscientiously patient evaluation is inevitable in transcatheter aortic valve implantation. Major focus should be put on improvement of quality of life and avoidance of postoperative morbidity.