Transaortic Transcatheter Aortic Valve Implantation: Learning Curve, Perioperative, and Midterm Follow-Up Results of a Single Center
DOI:
https://doi.org/10.1532/hsf.2249Abstract
Background: We present our initial institutional experience with transaortic (TAo) transcatheter aortic valve implantation (TAVI) using a self-expanding aortic bioprosthesis.
Methods: A total of 106 patients underwent TAo TAVI with Medtronic CoreValve through a small partial upper sternotomy. We focus our analysis on the overall perioperative results, procedural learning curve (first 30 patients), and midterm follow-up outcomes.
Results: VARC-2 device success was achieved in 95 patients (89%), and there were no intraoperative deaths. Nine patients (8.4%) required a second valve and conversion to standard surgery was required in 2 patients (1.8%). The final aortic insufficiency was grade 0 in 65 patients (62%) and grade 1 in 39 (37%). Although patients treated in the TAo TAVI learning phase required a significantly longer radiation time and contrast agent use, device success (93.4% versus 88.2%; P = .7) and prostheses hemodynamics were similar. All-cause mortality at 30 days was 12% (13/106). At a median follow-up of 392 days (IQR: 216-494 days) estimated overall 1-year survival was 72%. No significant differences were reported in terms of 30-day and 1-year observed mortality, and estimated 1-year survival in the learning and later phase of TAo TAVI.
Conclusion: TAo TAVI can be performed safely even in the very early phase of the learning curve. Although satisfactory results can be achieved from the beginning, a significant reduction in contrast agent use and radiological exposure are expected as the technique is mastered. Good hemodynamics have been documented and should be further improved with modifications achieved in the TAVI self-expandable valves technology.
References
Amrane H, Porta F, Van Boven AV, Kappetein AP, Head SJ. 2017. A meta-analysis on clinical outcomes after transaortic transcatheter aortic valve implantation by the Heart Team. EuroIntervention 13:e168-e176.
Bapat V, Frank D, Cocchieri R, et al. 2016. Transcatheter aortic valve replacement using transaortic access: experience from the Multicenter, Multinational, Prospective ROUTE Registry. JACC Cardiovasc Interv 9:1815-22.
Barbanti M, Petronio AS, Ettori F, et al. 2015. 5-Year outcomes after transcatheter aortic valve implantation with CoreValve prosthesis. JACC Cardiovasc Interv 8:1084-91.
Bruschi G, De Marco F, Botta L, et al. 2015. Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience. Int J Cardiol 181:437-42.
Fröhlich GM, Baxter PD, Malkin CJ, et al. 2015. National Institute for Cardiovascular Outcomes Research. Comparative survival after transapical, direct aortic, and subclavian transcatheter aortic valve implantation (data from the UK TAVI registry). Am J Cardiol 116:1555-9.
Leon MB, Smith CR, Mack M, et al. 2010. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597-1607.
Linke A, Wenaweser P, Gerckens U, et al. 2014. Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study. Eur Heart J 35:2672-84.
Petzina R, Lutter G, Wolf C, et al. 2017. Transaortic transcatheter aortic valve implantation: experience from the Kiel study. Interact Cardiovasc Thorac Surg 24:55-62.
Popma JJ, Adams DH, Reardon MJ, et al. 2014. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol 63:1972-81.
Reardon MJ, Adams DH, Coselli JS, et al. 2014. Self-expanding transcatheter aortic valve replacement using alternative access sites in symptomatic patients with severe aortic stenosis deemed extreme risk of surgery. J Thorac Cardiovasc Surg 148:2869-76.
Smith CR, Leon MB, Mack MJ, et al. 2011. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187-98.
Suri RM, Minha S, Alli O, et al. 2016. Learning curves for transapical transcatheter aortic valve replacement in the PARTNER-I trial: Technical performance, success, and safety. J Thorac Cardiovasc Surg 152:773-80.e14.
Thourani VH, Li C, Devireddy C, Kilgo P, et al. 2015. High-risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques. Ann Thorac Surg 99:817-23.
Thourani VH, Jensen HA, Babaliaros V, et al. 2015. Transapical and transaortic transcatheter aortic valve replacement in the United States. Ann Thorac Surg 100:1718-26.
