Transapical Aortic Valve Implantation in Rouen: Four Years' Experience With the Edwards Transcatheter Prosthesis

Arch Cardiovasc Dis. 2012 Mar;105(3):141-5. doi: 10.1016/j.acvd.2012.02.005. Epub 2012 Mar 21.

Abstract

Background: The first French transapical transcatheter aortic valve implantation (TAVI) was performed in July 2007 in our department.

Aims: To report 4-year outcomes of transapical implantation with the Edwards transcatheter bioprosthesis.

Methods: We prospectively evaluated consecutive patients who underwent transapical implantation with an Edwards transcatheter bioprosthesis between July 2007 and October 2011. Patients were not suitable for conventional surgery (due to severe comorbidities) or transfemoral implantation (due to poor femoral access).

Results: Among 61 patients (59.0% men), mean logistic EuroSCORE was 27.5 ± 14.9% and mean age was 81.0 ± 6.8 years. Successful valve implantation was achieved in 59/61 patients (96.7%) of patients. The other two patients required conversion to conventional surgery due to prosthesis embolization and died. Six additional patients died in the postoperative period. Causes of perioperative death were two septic shocks (one of peritonitis), two multi-organ failure, one ventricular fibrillation and one respiratory insufficiency. Intraprocedural stroke was not observed in any patient. The actuarial survival rates at 1, 2 and 4 years were 73.8%, 67.2% and 41.0%. During this 4-year period, four patients died of cardiovascular events, but no impairment of transprosthesis gradient was observed.

Conclusion: Our series of 61 patients who underwent transapical implantation of the Edwards transcatheter bioprosthesis shows satisfactory results, similar to other reports, considering the high level of severity of patients referred for this method. Transapical access is a reliable alternative method for patients that cannot benefit from a transfemoral approach.

Publication types

  • Comparative Study

MeSH terms

  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / mortality
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Bioprosthesis*
  • Cardiac Catheterization / methods*
  • Cardiac Catheterization / mortality
  • Coated Materials, Biocompatible*
  • Echocardiography, Transesophageal
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Prospective Studies
  • Prosthesis Design
  • Severity of Illness Index
  • Stroke Volume / physiology
  • Survival Rate / trends
  • Time Factors

Substances

  • Coated Materials, Biocompatible