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International Society For Minimally Invasive Cardiothoracic Surgery

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New Intercostal Access for Transcatheter Aortic Valve Replacement (tavr) - A Single-center Analysis
Katharina Svatikov, Katharina Huenges, Georg Lutter, Christine Friedrich, Assad Haneya, Jochen Cremer, Hatim Seoudy, Derk Frank, Thomas Puehler
UKSH Kiel, Kiel, Germany

BACKGROUND:Transfemoral (TF) Transcatheter Aortic Valve Replacement (TAVR) has an increasing use in treating severe aortic valve stenosis. Nevertheless, TAVR patients who are not suitable for TF-TAVR may need an alternative minimally invasive TAVR access. A newly applied intercostal parasternal (PS) transaortic TAVR approach is evaluated for subsequent patients.
METHODS: In a retrospective single-center study all surgical TAVR procedures between 10/2008 and 02/2019 were analyzed regarding all common characteristics. Three different TAVR approaches (transapical (TA), conventional transaortic ((c) TAo), and parasternal, PS-TAo) were evaluated out of 609 TAVR patients (n=271 TA, n= 306 cTAo, n=32 PS-TAo). Additionally a matched intergroup comparison in a 1:1:1 ratio was performed.
RESULTS: The mean age was 80.7 5.9 years for all patients. The overall gender distribution was equated. The median log EuroScore I was 18.6% (IQR 13.3-28.1%) and the comorbidities and perioperative risk-factors were equally distributed between the three groups. The 30-day mortality in the PS-TAo group was numerically lower than in the other groups but revealed no significance due to low sample size (TA: 7.2%, cTAo 12.5%, PS: 6.3%, p=0.074). Similar results within the three groups for the most parameters were obtained, but with a significantly lower ventilation rate (TA 17%, cTAo 10%, PS 8%, p=0.017) and a shorter length of ICU-stay (median, days) for the patients in the PS-TAVR group (TA 2 (2;4), cTAo 2 (2;5), PS 1 (1;3), p=0.017).
CONCLUSIONS:
The parasternal TAVR is a safe approach which allows good perioperative and postoperative outcome. Compared to the established TA and conventional TAo access site the perioperative outcomes are similar, but with significant shorter ventilation and ICU- times, as well as a lower 30-day and 12-months mortality rate


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