International Society For Minimally Invasive Cardiothoracic Surgery

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Does Transapical Transcatheter Aortic Valve Implantation Cause Further Reduction In Ejection Fraction?
Manoras M. Chengalath, Jr., Indran Ramanathan.
Greenlane Clinic, Auckland City Hospital, Auckland, New Zealand.

Background Transcatheter aortic valve implantation (TAVI) is becoming a choice of procedure for severe aortic stenosis where surgical intervention is deemed high risk. It is often thought that the transapical technique causes reduction in ejection fraction as it involves handling the left ventricle directly. The outcomes of patients undergoing transapical (TA) technique in our centre were investigated. Methods We studied retrospectively patients who underwent transapical TAVI at Auckland City hospital between March 2012 and December 2018. We also looked into the demographic characteristics, preoperative risk factors as well as intraoperative and postoperative outcomes. Results Twenty four patients (11male and 13female) underwent transapical TAVI. The median age was 84 years, the median EuroSCORE II was 11% and 70% had previous cardiac surgery. Apart from one patient who underwent two valve implantation, rest of the procedures went uneventful. The median hospital stay was 5 days. Nearly 15% had new onset atrial fibrillation and 6% had heart block. Preoperative median ejection fraction (EF) was 55% and median postoperative EF 60%. We did not have any intraoperative mortality. There was one in hospital death. Our analysis shows no reduction in ejection fraction post transapical procedure. Conclusions The transapical approach could equally produce good early and mid-term results when appropriately matched to patient characteristics. The ejection fraction of patients does not seem to be affected by this technique. More study may be required to gain a statistical significance.

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