Transapical Aortic Valve Implantation Research Articles

Combining Minimally Invasive Direct Coronary Artery Bypass Grafting with Transapical Aortic Valve Implantation-The Next Level Heart Team Approach.

For patients presenting with aortic stenosis and coronary artery disease, a simultaneous procedure addressing both diseases is recommended to reduce operative risk. In high-risk patients with hostile femoral or coronary axis, taTAVI-MIDCAB can be an alternative minimally invasive approach, offering the benefits of left interior mammary artery to left anterior descending coronary artery (LIMA-LAD) grafting. From 2014 to 2022, 10 patients underwent taTAVI-MIDCAB for combined coronary and severe aortic stenosis in the hybrid operation theater at our institution. We assessed perioperative outcomes and follow-up outcomes. The median age was 83 years (81 to 86). The procedure was successfully performed in all patients without conversion to sternotomy. The median length of hospital and intensive care unit stay was 9 days (7 to 16) and 2.5 days (1 to 5), respectively. The median flow over the coronary artery bypass was 31 (22 to 44) mL/min, with a pulsatility index (PI) of 2.4 (2.1 to 3.2). Mild paravalvular leak occurred in 2 patients (10%). There were no neurological events nor acute kidney injury. Pacemaker implantation was required in 1 patient (10%). Simultaneous surgical coronary revascularization and interventional valve implantation in the setting of a hostile femoral and coronary axis appears to be safe and beneficial.

Sex differences and estrogen effects in cardiac mitochondria in human aortic stenosis and in the mouse heart.

Sex differences in the adaptation to pressure overload have been described in humans, as well as animal models, and have been related to sex-specific expression of mitochondrial genes. We therefore tested whether sex differences in cardiac mitochondrial respiration exist in humans with aortic stenosis (AS). We also examined whether these potential differences may be at least partially due to sex hormones by testing if mitochondrial respiration is affected by estrogen (17ß-estradiol (E2)). Consecutive patients undergoing transapical aortic valve implantation (TAVI) (women, n = 7; men, n = 10) were included. Cardiac biopsies were obtained during TAVI and used directly for mitochondrial function measurements. Male and female C57BL/6J mice (n = 8/group) underwent sham surgery or gonadectomy (GDX) at the age of 2 months. After 14 days, mice were treated once with intraperitoneally injected vehicle (placebo), 17ß-estradiol (E2), estrogen receptor alpha (ERα) agonist [propyl pyrazole triol (PPT)], or ER beta (ERβ) agonist (BAY-1214257). Thereafter, mitochondrial measurements were performed directly in cardiac skinned fibers from isolated left ventricles and musculus solei. Mitochondrial State-3 respiration was higher in female than that in male human heart biopsies (15.0 ± 2.30 vs. 10.3 ± 2.05 nmol/mL/min/mg, p< 0.05). In the mouse model, mitochondrial State-3 respiration decreased significantly after GDX in female (27.6 ± 1.55 vs. 21.4 ± 1.71 nmol/mL/min/mg; p< 0.05) and male hearts (30.7 ± 1,48 vs. 23.7 ± 2,23 nmol/mL/min/mg; p< 0.05). In ovariectomized female mice, E2 and ERβ-agonist treatment restored the State-3 respiration to intact placebo level, whereas ERα-agonist treatment did not modulate State-3 respiration. The treatment with E2, ERα-, or ERβ-agonist did not modulate the State-3 respiration in GDX male mice. We identified sex differences in mitochondrial respiration in the diseased human heart. This is in alignment with known sex differences in the gene expression and proteome level at the functional level. E2 and ERβ affect cardiac mitochondrial function in the mouse model, suggesting that they may also contribute to the sex differences in the human heart. Their roles should be further investigated.

A clinical case of transapical aortic valve implantation for low-gradient stenosis in a comorbid patient with COVID-19-associated pneumonia

Aortic stenosis is the leading entity in the structure of valvular pathology in adult population with the frequency ranging from 2 to 4% in the general population. The distinct features of this defect include slow progression and frequent lack of correlation between the severity of stenosis according to clinical and instrumental data. The article presents the case of successful transcatheter aortic valve implantation by transapical access in a 71-year-old patient with symptomatic low-flow, low-gradient aortic stenosis, heart failure with preserved left ventricular ejection fraction, a history of coronary artery bypass grafting, severe concomitant pathology, and recent moderate COVID-19 coronavirus infection. The complexity of management of elderly patients with combined pathology is updated, and a multidisciplinary approach to clinical decision-making in a high-risk clinical situation is demonstrated.

The first experience of transcatheter implantation of aortic valve prosthesis «Medlab-KT» in the Far Eastern federal district

The results of transcatheter implantation of the fi rst Russian aortic valve prosthesis «MedLab-CT» are&#x0D; presented in the article. Transapical aortic valve implantation with MedLab-CT prosthesis was performed in 28 patients&#x0D; with a high surgical risk of severe aortic stenosis and concomitant pathology (EuroScore II 5,44). The operations were&#x0D; performed in a hybrid operating room, and the average duration time was 90 minutes. Concomitant stent-assisted coronary&#x0D; intervention was conducted in three patients. There were no cases of conversion to artifi cial blood circulation. At&#x0D; the hospital stage, two patients (7 %) died due to multiple organ failure that developed after surgery. Two patients (7 %)&#x0D; required an implantation of a permanent pacemaker. There were no cases of migration and dislocation of the prosthesis&#x0D; and rethoracotomy. The mean gradient on the valve was 6 mmHg, the maximum was 12 mmHg. The signifi cant&#x0D; intravalvular and paraprosthetic regurgitation was not observed. The average stay in the intensive care unit was about&#x0D; one day and approximately 12 days in the surgical department after the operation. The fi rst experience of implantation&#x0D; of a transcatheter «Medlab-CT» aortic prosthesis in the Far East Federal District allows making a conclusion that we&#x0D; obtained good clinical and hemodynamic results, which are consistent with the results of other authors using this valve.

Trans-apical aortic valve implantation for quadricuspid aortic valve with aortic regurgitation using J-valve system: a case reports

BackgroundQuadricuspid aortic valve (QAV) is a rare congenital heart defect usually accompanied with different hemodynamic abnormalities. Due to the rarity of QAV, treatment and prognosis of QAV patients with aortic regurgitation still remain challenging. We here present the first case of a patient with severe QAV regurgitation who underwent successful treatment and performed favorable prognosis with transapical aortic valve implantation (TAVI) using J-Valve system.Case presentationA 62-year-old man experienced intermittent palpitation, shortness of breath and chest pain. Echocardiography revealed congenital QAV with massive aortic regurgitation and mild aortic stenosis, left ventricular enlargement. Aortic valve replacement was successfully performed with TAVI using J-Valve system. The postoperation and follow-up was uneventful.ConclusionTAVI using J-Valve system has emerged as a new high success rate method for treatment of patients with simple non-calcified aortic valve insufficiency.

Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Implantation for Aortic Stenosis and Porcelain Aorta with a Systematic Review of Transfemoral versus Transapical Approach.

We have aimed to analyze early and mid-term outcomes of patients undergoing transapical/transfemoral transcatheter aortic valve implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo) in our institution. Additionally, we postulated that the TA approach may be associated with a more favorable neurological outcome than the TF approach; hence, a systematic literature review was conducted. Between 2011 and 2017, 15 patients with PAo underwent TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment of PAo was done either intraoperatively after aborted sternotomy or via computed tomography for elective TAVI. We conducted mid-term follow-up. Furthermore, a systematic review was performed to compare the mortality and neurological outcomes of TF and TA-TAVI approaches. TA/TF-TAVIs were performed with 100% device success, without paravalvular leakage ≥ 2 and without procedural death. The 30-day mortality/stroke rates were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month, 1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%, and 50%/0%, respectively.The pooled results derived from the literature review were as follows: The prevalence of PAo in the TAVI population is 9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI. TA-TAVI shows promising early and mid-term outcomes in patients with PAo. TF-TAVI performed in patients with PAo is likely to be associated with higher rates of stroke than TA-TAVI.

Pulsatile sterile abscess in the left breast following transapical transcatheter aortic valve implantation: a case report.

BackgroundOver the last decade, transcatheter treatment of degenerative aortic valve stenosis has been established as an alternative to surgical aortic valve replacement. Late complications of transcatheter treatment of aortic stenosis (AS) are infrequent.Case summaryWe report an 87-year-old woman treated successfully with 23 mm Sapien 3 transapical transcatheter aortic valve implantation for severe AS. She presented 4 months later with a pulsatile mass in the left breast. After exclusion of other diagnoses, the mass was attributed to a sterile abscess communicating with the pericardial cavity due to post-operative chest infection and pleural effusion. Multimodality imaging helped to define the anatomy of the abscess and the mechanism of the pulsation.DiscussionThis is the first report of a pulsatile sterile abscess occurring as a complication of transapical aortic valve implantation. Multimodality imaging confirmed that the pulsation was due to extension of the abscess into the pericardial cavity, excluded direct communication with the left ventricle, and facilitated successful non-surgical management.

Completely Percutaneous Transaxillary Aortic Valve Implantation Under Local Anesthesia: A Minimalist Alternative Access Approach

An 80-year-old man with severe aortic stenosis and history of coronary artery bypass grafting and extensive peripheral artery disease underwent a failed transapical aortic valve implantation attempt complicated by apical tear and bleeding. A completely percutaneous transaxillary aortic valve

RETRACTED: Rhomboid intercostal and subserratus plane block for transapical transcatheter aortic valve implantation

RETRACTED: Rhomboid intercostal and subserratus plane block for transapical transcatheter aortic valve implantation

EP25 OPTIMAL OPERATIVE PLANNING AND HIGH-EXPERIENCE ARE PREDICTORS OF GOOD OUTCOMES IN PATIENTS UNDERGOING TRANS-APICAL VALVE IMPLANTATION

Background and Aim: With the improvement in surgical expertise and optimization of pre-operative cardiovascular imaging techniques, trans-apical (TA) valve implantation has become in expert hands a rapid and safe procedure, with low rates of complications and conversion to surgery. The aim of our study is to demonstrate that high experienced surgeon with &gt; 500 procedures and optimal operative planning are predictors of good outcomes. Methods: We included 45 patients who underwent TA aortic or mitral valve implantation from March 2017 to March 2018 in our Centre. We evaluated early clinical and echocardiographic outcomes according to Valve Academic Research Consortium (VARC-2) definitions. Results: Median age was 80 year-old (IQR 77–82), median Logistic Euroscore was 5.8% (IQR 3.8–10). Three patients underwent TA mitral valve-in-valve implantation (TA-MVinV), 5 TA aortic valve-in-valve implantation (TA-AVinV) and 37 TA aortic valve implantation (TA-AVI), with 3 different prostheses (Figure1A). Device success was 100%. There were no intra-operative deaths nor conversions to conventional surgery. At 30-day follow up (FU), no deaths nor major cardiac/vascular complications occurred. We reported 1 stroke (2.2%) and 3 acute kidney injuries (6.7%), of which only 1 patient needed continuous veno-venous hemofiltration. Two patients (4.4%) presented transient conduction disturbances and 1 (2.2%) underwent permanent pacemaker implantation. Figure1B-C reports peak and mean gradients at 30-day FU. Conclusions: In heart valve Centers, experienced surgeons (&gt;500 procedures) and optimal operative planning result in low mortality and complication rates after TA valve implantation.

Transapical and Transfemoral Aortic Valve Implantation. Impact and General Considerations of both Approaches

Transapical and Transfemoral Aortic Valve Implantation. Impact and General Considerations of both Approaches

Prospective multicentre evaluation of a novel, low-profile transapical delivery system for self-expandable transcatheter aortic valve implantation: 6-month outcomes.

We assessed the safety and efficacy of a novel low-profile, 22-Fr transapical delivery system together with the ACURATE neo™ resheathable transcatheter heart valve. This prospective, single-arm, multicentre study enrolled 60 patients with severe symptomatic aortic stenosis and high surgical risk ineligible for transfemoral access. Primary end points were 6-month mortality and procedural success. The mean age of patients was 79.8 ± 4.7 years, and the patients had severe comorbidities including coronary artery disease (71.7%), diabetes (38.3%), atrial fibrillation (30.0%) and chronic obstructive pulmonary disease (21.7%); logistic EuroSCORE-I, -II and the Society of Thoracic Surgeons (STS) scores were 20.9 ± 8.9%, 6.1 ± 5.0% and 4.3 ± 2.9%, respectively. A non-rib spreading approach using soft tissue retractors only was used in 88.3% of patients (n = 53). Resheathing and repositioning of transcatheter heart valve were performed in 6.7% of cases (n = 4); the device implantation time was 3 ± 2 min. Apical access site complications occurred in 1.7% (n = 1). Procedural success was 98.3% (n = 59), and procedural success in the absence of major adverse cardiac and cerebrovascular events at 30 days was 90.0% (n = 54). At 30 days, cardiovascular and overall mortality were 8.3% (n = 5), stroke rate was 1.7% (n = 1), and 17.2% of patients (n = 10) received a permanent pacemaker implant. No paravalvular leakage ≥2+ was observed, and the mean transvalvular gradient was 5.9 ± 2.7 mmHg. At 6 months, survival was 84.3% with sustained haemodynamic results. This study indicates safety and efficacy of transapical aortic valve implantation using a novel low-profile delivery system. High procedural success, short implantation times and a low rate of apical access site complications underline the favourable safety profile and ease of use. ClinicalTrials.gov: NCT02950428.

The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation.

We present 1-year outcomes of the post-market registry of a next-generation transcatheter heart valve used for aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is routine in high-risk patients with aortic stenosis but is not recommended for AR. The JenaValve™ (JenaValve Technology GmbH, Munich, Germany) overcomes technical challenges in AR patients through a leaflet clipping mechanism. The JenaValve EvalUation of Long Term Performance and Safety In PaTients with SEvere Aortic Stenosis oR Aortic Insufficiency (JUPITER) Registry is a European study to evaluate safety and effectiveness of this THV. From 2012-2015, 30 patients with AR were enrolled. Mean age was 74.4 ± 9.3 years. Procedural success was 96.7% (29/30). One patient was converted to open surgery. No annular rupture or coronary ostia obstruction occurred. Mortality at 30 days was 10.0% (3/30). Combined safety endpoint was met in 13.3% (4/30). Paravalvular regurgitation was not present/trivial in 84.6% (22/26) and mild in 15.4% (4/26). Rate of permanent pacemaker implantation was 3.8% (1/26). One-year Kaplan-Meier survival was 79.9%, one-year combined efficacy was 73.1% (19/30). No further strokes were observed during 1 year of follow-up. The JenaValve overcomes technical challenges of TAVR in AR through a clipping mechanism. We report satisfactory outcomes of a multicenter registry using the JenaValve for predominant AR, as rate of THV embolization, residual AR and permanent pacemaker implantation was low. One-year results using the JenaValve for AR encourage its use for this indication.

Evolution of anaesthesia in transapical aortic valve implantation Running head: Anaesthesia and transcatheter valve

Evolution of anaesthesia in transapical aortic valve implantation Running head: Anaesthesia and transcatheter valve

Early- and Medium-Term Results after Transapical Aortic Valve Implantation

Objective: The aim of this study was to evaluate early and late outcome to determine the preoperative predictors of in-hospital and medium-term mortality in patients undergoing transapical transcatheter aortic valve implantation (TA AVI) severe aortic valve stenosis.

Prior Prosthetic Hip Replacement Is Related to Different Outcomes of Transapical versus Transfemoral Transcatheter Aortic Valve Implantation

Prior Prosthetic Hip Replacement Is Related to Different Outcomes of Transapical versus Transfemoral Transcatheter Aortic Valve Implantation

Porcelain Aorta is Associated with Higher Vascular Complication Rates after Transfemoral versus Transapical Transcatheter Aortic Valve Implantation

Porcelain Aorta is Associated with Higher Vascular Complication Rates after Transfemoral versus Transapical Transcatheter Aortic Valve Implantation

Apical closure device for full-percutaneous transapical valve implantation: stress-test in an animal model†.

Transapical valve implantation is traditionally performed through a left antero-lateral mini-thoracotomy. A self-expandable apical closure device has recently been developed for full-percutaneous transapical valve implantation. We performed haemodynamics stress-tests on an animal model to evaluate the sealing properties. Under general anaesthesia 5 pigs (mean weight: 67 ± 6 Kg) received full heparinization (100 IU/Kg; activated clotting time >250 s and, through inferior mini-sternotomies, 21-Fr introducer sheaths for transapical aortic valve implantation (outer diameter: 25-Fr) were placed over-the-wire in the apexes. Delivery-catheters carrying folded occluders (SAFEX TM final design) were inserted in the introducer sheaths and plugs were then deployed under fluoroscopic guidance. Phase 1: after protamine injection, apical bleeding was monitored for 1 h with standard haemodynamics condition. Phase 2: we induced systemic hypertension with adrenaline infusion to test the sealing properties under stress. Animals were sacrificed after Phase 2 and hearts were removed and inspected. Five plugs were successfully introduced and deployed in 5 pig hearts. Plugs provided good apical sealing in each animal and a mean of 7 ± 4 ml of blood lost per animal was collected during Phase 1: haemodynamics remained stable and no plug dislodgement was detected (mean blood pressure: 52 ± 9 mmHg). During Phase 2, mean systolic and diastolic peak levels reached 268 ± 24 mmHg and 175 ± 17 mmHg, respectively, without plug dislodgment or bleeding. Post-mortem inspection showed good plug deployment and fixation without myocardial damage. The new apical occluder seals large-sized apical access sites in animal models also during induced systemic hypertension. This pilot study is a further step towards full-percutaneous transapical valve procedures in the clinical setting.

Transapical aortic valve implantation using a Symetis Acurate self-expandable bioprosthesis: initial outcomes of 10 patients.

IntroductionTransapical aortic valve implantation (TA-AVI) has been widely introduced for treatment of patients with severe aortic stenosis in the last decade. Here we report our first clinical experience with 10 patients using the second-generation transapical Symetis Acurate TA aortic valve designed for transapical implantation.AimTo evaluate the results of transapical access in transcatheter aortic valve implantation (TAVI) among patients with unsuitable vascular access.Material and methodsAll patients had been assessed by a local heart team and were disqualified from surgical aortic valve replacement (AVR) and the transfemoral TAVI approach. Mean age was 75.4 ±3.9 years (range: 68–80), with 20% being female. Logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) and STS (Society of Thoracic Surgeons) were 15.4 ±8.9% and 20.5 ±4.5%, respectively.ResultsAll implantations were performed successfully in the intra-annular and subcoronary position. There were no conversions to surgical AVR. All patients survived 30-day follow-up. No strokes or transient ischemic attacks were reported. There was no need for pacemaker implantation and none of the patients demonstrated moderate or significant paravalvular leakage. The mean aortic gradients improved significantly from a baseline of 57.0 ±19.2 mm Hg to a 30-day value of 14.2 ±4.1 mm Hg.ConclusionsOur initial clinical results indicate satisfactory functionality in patients after trans-apical implantation of the Symetis Acurate aortic valve. The procedure of implantation seems to be straightforward and may be considered in patients in whom a transfemoral approach is not a good option.

Bağcılar Eğitim ve Araştırma Hastanesi’nde ilk transapikal aort kapak replasmanı

Transcatheter-based aortic valve procedures have undergone a tremendous evolution and have led to great changes in the treatment of aortic valvular disease. In patients with severe peripheral arterial disease, transapical aortic valve implantation is an important alternative to surgical aortic valve replacement. Hereby we present our first case of transapical aortic valve implantation in an 80 year-old patient. An 80-year old female patient applied with dyspnea on minimal exertion (NYHA Class III). Transthoracic echocardiography showed severe aortic stenosis (gradients of 76/45 mmHg, aortic valve area of 0.72 cm2). Patient had a history of coronary artery bypass grafting and chronic obstructive pulmonary disease. Calculated Euroscore was 16.4% and due to the high surgical risk and presence of diffuse vascular disease, transapical aortic valve implantation was decided to be the optimal choice for the patient. The procedure was performed in the catheter laboratory under general anesthesia via a 5-6 cm anterolateral thoracotomy and via transapical approach. Fluoroscopy was used to guide the catheter across the native valve and direct deployment of the stent at the level of the annulus. A 26 mm Edwards Novoflex (Edwards Lifesciences, Irvine, CA) aortic valve was used. Postoperative echocardiography showed no transvalvular gradient and aortic regurgitation. Aorta flow was 1.1 m/s. Transcatheter-based aortic valve procedures avoid the risks associated with open heart surgery and therefore are generally indicated in patients with high surgical risk. Although TAVI is the first alternative to SAVR in high risk patients, TA-TAVI is a safe and effective option in those unsuitable for TAVI.