Technical considerations to avoid pitfalls during transapical aortic valve implantation
| Autor: | Anson Cheung, Daniel R. Wong, Samuel V. Lichtenstein, Ronald G. Carere, John G. Webb, Jian Ye |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve medicine.medical_specialty Time Factors Heart Valve Diseases Prosthesis Design Radiography Interventional Risk Assessment Catheterization Pseudoaneurysm Aortic valve replacement Risk Factors Internal medicine Humans Medicine Hospital Mortality Stroke Ultrasonography Interventional Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation business.industry Cardiac Pacing Artificial Perioperative medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Thoracotomy Ventricle Aortic Valve Heart Valve Prosthesis Circulatory system cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Atrioventricular block Echocardiography Transesophageal |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 140:196-202 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2009.07.081 |
| Popis: | Objective Transapical aortic valve implantation is a recent therapeutic advance for aortic valvular disease. We sought to identify complications—and the relevant technical and management considerations—from our learning curve with this procedure. Methods We retrospectively reviewed perioperative complications during the first 60 transapical aortic valve implantations at a single institution, performed under compassionate release for patients who were candidates neither for conventional aortic valve replacement nor for transfemoral aortic valve implantation. Access was through a small left anterolateral thoracotomy. Particular attention was paid to securing the apical access site. Rapid ventricular pacing to reduce cardiac forward flow was used during balloon valvuloplasty and valve deployment. Careful positioning was guided by echocardiography and fluoroscopy. Results This was a select, high-risk (mean Society of Thoracic Surgeons score, 12.3% ± 7.8% mortality) cohort. Mean age was 81.1 ± 7.8 years. Technical success was achieved in 59 (98.3%) cases. One valve was malpositioned too far toward the ventricle, necessitating that a second device be implanted within it. In-hospital, 30-day mortality was 18.3% (11 deaths) overall, decreasing from 33.3% in the first 15 patients to 13.3% in the subsequent 45 patients. The only intraoperative death probably resulted from left main ostial obstruction by extensively calcified aortic cusps. Significant left ventricular apical bleeding occurred in 3 (5.0%) patients. Other complications included stroke in 2 (3.3%) patients and permanent atrioventricular block in 3 (5.0%). There were 4 (6.6%) cases of late pseudoaneurysm of the left ventricular apical access site. Conclusions Important lessons have been learned from our early experience with transapical aortic valve implantation, and these may guide others as this technology is adopted more broadly. |
| Databáze: | OpenAIRE |
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