Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience
| Autor: | Giuseppe Bruschi, Sandra Nonini, Cristina Giannattasio, Silvia Mauri, Luca Botta, Silvio Klugmann, Paola Colombo, Francesco Soriano, Federico De Marco, Tiziano Colombo, Nuccia Morici, Alberto Barosi, Pasquale Fratto, Michele Mondino, Aldo Cannata |
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| Přispěvatelé: | Bruschi, G, De Marco, F, Botta, L, Barosi, A, Colombo, P, Mauri, S, Cannata, A, Morici, N, Colombo, T, Fratto, P, Nonini, S, Soriano, F, Mondino, M, Giannattasio, C, Klugmann, S |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Aortic valve
Male medicine.medical_specialty Aortic stenosi medicine.medical_treatment Hemodynamics Transcatheter valve replacement Regurgitation (circulation) Single Center Transcatheter Aortic Valve Replacement Minimally invasive surgery Internal medicine medicine Humans Thoracotomy Aged Aged 80 and over business.industry Aortic Valve Stenosis MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE medicine.disease Surgery Stenosis Catheter medicine.anatomical_structure Cardiology Female Cardiology and Cardiovascular Medicine business Right anterior Follow-Up Studies |
| Popis: | Objective Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac–femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients. Methods From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2±6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures. Results Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5mmHg. The paravalvular regurgitation was ≤ grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2years is 84.7±5.3%. Conclusions Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure. |
| Databáze: | OpenAIRE |
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