The Kiel Experience With The Transaortic (tao) Approach For Tavi Procedures - An Update
Katharina Huenges, Katharina Kreipe, Markus Neu, Vincent Christiansen, Jochen Cremer, Rainer Petzina, Norbert Frey, Georg Lutter, Derk Frank.
UKSH Kiel, Kiel, Germany.
OBJECTIVE: In the past years the field of transcatheter aortic valve implantations (TAVI) has undergone a rapid evolution. Nowadays a various number of valve prostheses, different devices and implantation techniques are available for clinical routine. The transaortic (TAo) approach has evolved as the standard surgical approach at our center since 2012. The experiences with TAo-TAVI procedures using two different valve prostheses are presented in this study.
METHODS: All TAVI cases were discussed in our interdisciplinary Heart-Team and the patients were included in a prospective registry. Here, consecutive TAo-TAVI procedures using either the balloon-expandable SAPIEN 3 (S3; Edwards Lifesciences) or the self-expandable CoreValve Evolut R (ER; Medtronic) were analyzed. Baseline demographics and periprocedural characteristics were documented. Follow-up evaluation included 7-days, 30-days and annual visits. Transthoracic echocardiography (TTE) focused on valve performance and TAVI results were categorized according the current Valve Academic Research Consortium (VARC)-2 criteria.
RESULTS: A total of 149 patients between 02/2014 and 09/2016 received a TAo-TAVI procedure, the S3 valve was used in 75.2% (n=112) and the ER in 24.8% (n=37) cases. Mean age at time of implantation was 81±6 years and 61.7% (n=92) were female. Preoperative EuroScore-II was 7.68±6.01 and STS 6.19±4.42. TAo procedure was a redo cardiac surgery in 20.8% (n=31). Mean procedure duration was 110±38 min. According the VARC-2 criteria life-threatening bleeding occurred in 4.7% (n=7) of all cases. Conversion to open cardiac surgery was required in one case (0.7%). A cardiac tamponade occurred in 2.7% (n=4). Stroke, including transient-ischemic attack, was diagnosed in 3.4% (n=5). The 7d-TTE showed no paravalvular leakage (PVL) in 77.1% (S3 83%; ER 58.1%) and only moderate PVL in 1.5% (S3 0%; ER 6.5%), there was no occurrence of severe PVLs. A low rate of required permanent pacemaker implantation was noted with 8.7% (n=11). The 30-days mortality was tolerably low with 5.4% (n=8).
CONCLUSIONS: We here present further results with the current TAVI devices using transaortic approach. A low periprocedural complication rate occurred after TAo-TAVI procedure.
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