Key result
Surgeon-performed transapical TAVR in high-risk severe AS is linked to ~1% 30-day mortality.
Why the study?
The authors sought to evaluate experience performing transapical TAVR with a balloon-expandable valve by cardiac surgeons with on-site interventional cardiology support.
Is transapical TAVR with a balloon-expandable valve performed by cardiac surgeons safe and effective in high-risk patients with severe aortic stenosis?
Observational (n=97)
No
Is transapical TAVR with a balloon-expandable valve performed by cardiac surgeons safe and effective in high-risk patients with severe aortic stenosis?
Transapical TAVR performed by cardiac surgeons with interventional support is safe and effective in high-risk patients with severe aortic stenosis, demonstrating low mortality and favorable left ventricular reverse remodeling.
Supports surgeon-led transapical TAVR feasibility in high-risk aortic stenosis; leaves open randomized comparisons to other access routes.
BACKGROUND: The purpose of this study is to report our experience in performing transapical (TA) TAVR with a balloon-expandable valve only by cardiac surgeons, with on site interventional cardiology support. METHODS: A retrospective review of 97 consecutive patients that underwent TA TAVR due to severe symptomatic aortic stenosis was performed from 2012 to 2016. Median follow-up time was 20.5 months. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions. RESULTS: All patients were high risk with a mean Euroscore of 7.28±7.77. Five year and 30-day mortality were 9.3 % and 1.1 %, respectively. Ninty six (98.9 %) of the patients had no or mild paravalvular leak seen by transesophageal echocardiography after implantation. Device success was 91.8%. Postoperatively there was a significant increase of the ejection fraction (50.8±7.1 % preoperatively vs 53.1±7.7 % postoperatively, p=0.009) and reverse remodeling of the left ventricle (left ventricular end-diastolic diameter preoperatively 50.8±7.1 mm vs 49.2±8.1 mm postoperatively, p=0.031). CONCLUSION: Our experience demonstrates that TA TAVR can be performed only by cardiac surgeons, with on site interventional cardiology support safely and successfully with low and comparable postoperative mortality and rate of complications (Tab. 4, Fig. 1, Ref. 26).
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Hulman et al. (2019) conducted an observational in Severe symptomatic aortic stenosis (n=97). Transapical transcatheter aortic valve replacement (TA TAVR) was evaluated on 30-day mortality. Transapical TAVR performed by cardiac surgeons in high-risk patients with severe aortic stenosis resulted in a 30-day mortality of 1.1% and a 5-year mortality of 9.3%.
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