Transapical Aortic Valve Research Articles

P81 SIMULTANEOUS TRANS–APICAL AORTIC AND MITRAL VALVE IMPLANTATION IN A PATIENT WITH A DEGENERATED MITRAL BIOPROSTHESIS AND SEVERE AORTIC STENOSIS

Abstract Transcatheter Valve–in–Valve implantation has shown promising results in high–risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. This is a case of a 82–year–old man, with history of multiple previous mitral valve replacement, admitted to the hospital for heart failure. During diagnostic work out he was diagnosed with a severe aortic stenosis and structural degeneration of a mitral valve bioprostheses Epic 29mm, St Jude Medical, (Inc, St Paul, Minn, USA). The heart team defined the patient at high surgical risk profile and was therefore scheduled for a simultaneous mitral and aortic transcatheter valve implantation. Through a double trans–apical approach (Figure A and B), the patient underwent two balloon expandable valves (Sapien 3, Edwards Lifesciences, Irvine, CA, USA) deployment in native aortic (Figure C) and mitral bioprosthesis (Figure D), respectively. Final angiography showed lack of aortic (Figure E) and left atrial (Figure E) regurgitation. The procedure was uneventful as well as the following hospital stay. Post–procedural transesophageal echocardiography confirmed the absence of paravalvular leakage nor aortic or mitral regurgitation. The patient was discharged at home on day 7. Simultaneous transapical transcatheter aortic and mitral valve replacement is technically feasible with the current available technology and can be a possible alternative in patients with high surgical risk.

Transseptal antegrade transcatheter aortic valve replacement in a patient with severe aortic stenosis: a case report

We described a case report of transcatheter aortic valve replacement in conditions when the aortic stenosis anatomy does not make it possible to perform retrograde left ventricular catheterization, and the patient’s condition severity does not allow performing transapical or surgical aortic valve replacement. The presented technique of interatrial septal puncture with antegrade passage of the guidewire through the mitral and aortic valves and the venoarterial looping demonstrates an elegant way to solve this clinical situation, and can be adopted by specialists performing transcatheter interventions in severe aortic stenosis.

Abstract 16322: Safety and Efficacy of Transapical Transcatheter Aortic Valve Replacement in the Treatment of Pure Non-calcified Native Aortic Regurgitation

Background: Transcatheter aortic valve replacement (TAVR) in patients with pure aortic regurgitation (AR) is still “off-label” use due to the lack of suitable transcatheter heart valve. This study aimed to evaluate the safety and efficacy of TAVR with J-Valve TM (JieCheng Medical Technology Co., Ltd., Suzhou, China) transcatheter heart valve for the treatment of patients with pure non-calcified native AR. Methods: The clinical and follow-up data of patients with pure non-calcified native AR treated by TAVR with J-Valve TM between April 2014 and November 2019 in the West China Hospital were summarized. Procedural results and clinical outcomes were analyzed using Valve Academic Research Consortium-2 criteria. Results: A total of 123 patients were enrolled with a mean age of 72.1±6.4 years. There were 28 cases with bicuspid aortic valve and 95 cases with trilobal aortic valve. The median follow-up period was 18 months. Transapical implantation with J-Valve TM was successful in all patients (100%). By the end of the follow up, the rate of all-cause mortality was 5.7%, among which 5 cases died during the perioperative period. Other results include stroke (1.6%), new permanent pacemaker implantation (8.9%), major bleeding (6.5%), acute kidney injury (2.4%) and aortic valve-related re-intervention (3.3%, they were given surgical aortic valve replacement for thrombosis of artificial valve (2 cases) or severe post-procedural paravalvular leakage (2 cases)). Among the 112 survival cases without re-intervention, Echocardiography revealed that none of them had moderate or severe paravalvular leakage; mild and mild-moderate paravalvular leakage occurred in 9.8% and 8.0% cases, respectively. Mean transvalvular gradient after valve implantation was 9.2±3.5 mmHg. At 6 months of follow up, left ventricular end diastolic diameter was remarkably smaller compared to that before procedure (53.5±8.2 mm vs 64.3±8.9 mm, P<0.001) and left ventricular ejection fraction was significantly increased (56.3±11.8 % vs 54.2±12.4 %, P=0.031). Conclusions: TAVR with J-Valve TM transcatheter heart valve system for treatment of patients with pure non-calcified native AR is safe and effective which may be a reasonable option in the future treatment.

Transapical native aortic valve resection (in a human cadaver)

Transapical native aortic valve resection (in a human cadaver)

Multimodality imaging of left ventricular apical pseudoaneurysm after apical approach transcatheter aortic valve replacement.

Left ventricular pseudoaneurysm formation is a rare complication of transapical approach transcatheter aortic valve replacement. It can cause chest pain and shortness of breath or remain asymptomatic. Mortality rate is high, and therefore, timely diagnosis and management are essential. Different imaging modalities can provide anatomic or functional information and are essential for the primary diagnosis or during follow-up.

P1852The clinical experience of J valve transapical transcatheter aortic valve replacement system in high-risk patients with severe pure aortic regurgitation

Abstract Objective Patients with severe pure aortic regurgitation (PAR) undergoing transcatheter aortic valve implantation (TAVI) is still under controversial. J valve™, a China Food and Drug Administration (CFDA) certified device, has specific positioning and anchoring system, which makes this device indicated in PAR patients. We aim to introduce the clinical experience of J valve in the treatment of PAR in high risk patients. Methods A total of 53 severe PAR patients (STS score 6,3±1.8, mean age, 76.4±5.2 years) who underwent TAVI using J valve™ in our Hospital from June 2017 to December 2018 were retrospectively enrolled. All patients underwent echocardiography and contrast-enhanced computed tomography to evaluate their baseline and follow-up characteristics. The 30 days outcomes were reported according to the Valve Academic Research Consortium-2 (VARC) definitions. Results All patients underwent transapical TAVI, and J valve was in implanted successfully in 51 patients (96,2%). J valve was dislodged in two patients, one patient was successful implanted with another J valve and the dislodged valve placed in descending aorta. The other patient was converted to urgent surgery for aortic valve replacement. One patient was converted to surgery due to severe aortic regurgitation after J-valve placement. The 30 days mortality was 9.2% (n=5), 1 patient died of acute heart failure and 2 patients died of infection. During the hospitalization, none of the patients had stroke or transient ischemic attack (TIA) and periprocedural myocardial infarction (MI). There were 5 (n=14.3%) patients presenting with bleeding complications (BARC 4 definition of major bleeding). 1 (2.9%). Pacemaker implantation was performed in 2 (5.7%) patients. Paravalvular regurgitation was none or trace in 90.7% (n=49), mild to moderate in 5.6% (n=3), and moderate to severe 1.8% (n=1) after the procedure. Mean intensive care unit stay was 29.30±15.30 h. Working illustration of J valve Conclusion TAVI by J valve™ can be an alternative option for high risk patients with PAR, but more evidences are still needed to further prove its safety and feasibility.

P925Risk adjusted comparison of in-hospital outcomes of transapical transcatheter and surgical aortic valve replacement

Abstract Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) is the standard therapy for patients with severe aortic valve stenosis at high operative risk. If the transfemoral access is not possible, a transapical access is an alternative. However, it is known from randomized trials and large registries that outcomes after transapical TAVR (TA-TAVR) are inferior to TF-TAVR. Purpose We compared in-hospital outcomes of patients undergoing TA-TAVR or SAVR in a nationwide data-set, in order to identify patients' groups, who benefit from SAVR or TA-TAVR. Methods We identified all 13,151 isolated SAVR and 4,625 TA-TAVR performed in Germany 2014 and 2015 on the basis of ICD- and OPS codes. In order to compare outcomes, we adjusted for risk factors using a covariate adjusted analysis. Results Patients undergoing TA-TAVR were older (68 vs. 80 years), had more co-morbidities, and accordingly an increased logistic EuroSCORE (LogES 5.3 vs 16.7%). However, stroke, acute kidney injuries, relevant bleedings, and prolonged mechanical ventilation occurred less frequently in patients undergoing TA-TAVR (OR TA-TAVR vs SAVR: stroke 0.66, p=0.017; acute kidney injury 0.72, p=0.002; relevant bleeding: 0.38, p<0.001; prolonged mechanical ventilation >48h: 0.5, p≤0.001). The risk for a new permanent pacemaker was higher after TA-TAVR (OR 2.44, p≤0.001). Without adjustment in-hospital mortality was higher after TA-TAVR (2.0% vs. 5.9%). After covariate adjustment, the difference disappeared (OR TA-TAVR vs. SAVR 1.2, p=0.136). In order to identify subgroups, which may benefit from TA-TAVR or SAVR, we compared mortality in different subgroups after risk adjustment. Patients under 75 years (OR TA-TAVR vs. SAVR: 1.86, p=0.01) and female (OR 1.48, p=0.043) patients had a lower risk for in-hospital mortality after SAVR. In all other groups (age 75–79, 80–84, >85, log. EuroScore <4, 4–9,>9, NYHA III/IV, previous CABG, COPD, pulmonary hypertension, chronic renal failure, Diabetes) none of both treatment strategies was superior. Conclusion TA-TAVR is with regard to in-hospital mortality not superior to SAVR in clinical practice. Younger patients under 75 years and female patients benefit from SAVR. However, complications such as bleeding, stroke, or prolonged ventilation were less frequently in patients undergoing TA-TAVR.

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.

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

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

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

心尖部アプローチ経カテーテル大動脈弁置換術にオフポンプ冠動脈バイパス術を併施した1例

心尖部アプローチ経カテーテル大動脈弁置換術にオフポンプ冠動脈バイパス術を併施した1例

TCT-739 Twelve-month follow-up results of the STASIS trial: a multi-center study on a novel apical closure device for transapical transcatheter aortic valve implantation

TA access for TAVI has seen little standardization due to the absence of automated preclosure and carries a risk for bleeding and increased morbidity compared to TF TAVI. Here we report the 12-month follow-up of patients after use of a novel device to facilitate safe and reliable, automated access

Trans- apical transcatheter aortic valve replacement for patient with severe pure aortic regurgitation

Objective To explore the feasibility of transapical transcatheter aortic valve replacement (TF- TAVR) for patient with severe pure aortic regurgitation (AR). Methods A patientwith severe pure AR underwent TF- TAVR at the Second Affiliated Hospital of Zhejiang University School of Medicine on September 8, 2016, was retrospectively analyzedfor the preoperative assessment, procedural process and the postoperative recovery. Results A patient with pure AR was assessed before TF- TAVR carefully according to the inclusion criteria. General anesthesia and intubation were performed during the procedure. Apex was exposed in the fifth intercostal space under the guidance of X- ray, followed by purse- string suture. Terumo wire crossed aortic valve and went to descending aorta after puncture of apex. J- Valve system was inserted and released step by step. In comparison with severe AR before procedure, no AR was found from transesophageal echocardiography (TEE) monitoring after TF- TAVR. Before discharge, symptom of the patient was relieved and no severe complications such as death, myocardial infarction, pericardial tamponade and aorta dissection, except first degree atrioventricular block was found. Conclusions It is feasible and safe using TF- TAVR for severe pure AR, while follow- up is necessary for the evaluation of long- term prognosis. Key words: Transcatheter aortic valve replacement; Pure aortic regurgitation; Apex

Health-related quality-of-life after transapical transcatheter aortic valve implantation

Purpose. Transcatheter aortic valve implantation (TA-TAVI) is a well-established treatment for aortic valve stenosis in high-risk patients and indications have been continuously expanding to also include intermediate-risk patients. However, in low-risk patients, experiences are still sparse and although clinical outcomes have been shown favorable results, HRQoL has remained unexplored. The aim of this report was to describe the long-term health-related quality-of-life (HRQoL) in low-risk patients randomized to TA-TAVI or surgical aortic valve replacement (SAVR). Methods. In a prospective, randomized trial, patients with aortic valve stenosis were randomized to either TA-TAVI or SAVR. TA-TAVI was performed through a mini thoracotomy with the introduction of prosthesis via the apex of the heart and antegradely advancement over the pre-dilated native valve. SAVR was performed during cardiopulmonary bypass with resection of the native valve and replacement with a prosthesis valve through a median sternotomy. Afterwards, patients were followed yearly with echocardiography and HRQoL assessment. Results. A total of 58 patients were included; 29 patients for TA-TAVI and 29 patients for SAVR. The only difference in HRQoL was found in the physical component summary after 1 year; 44 ± 9 in the TA-TAVI group compared with 36 ± 9 in the SAVR group, p = .03. There were no differences in any of the remaining timepoints in neither physical nor mental component summary, p = .19 and p = .98, respectively, and there were no differences in survival during the 5 years. Conclusions. In low-risk patients with aortic valve stenosis undergoing TA-TAVI, no differences appeared in HRQoL compared with SAVR during a 5-year follow-up period.

The Impact of Chronic Obstructive Pulmonary Disease on Outcome in Patients Undergoing Transfemoral versus Transapical Transcatheter Aortic Valve Implantation: Data from the VIenna transCaTheter aOrtic valve RegistrY (VICTORY)

The Impact of Chronic Obstructive Pulmonary Disease on Outcome in Patients Undergoing Transfemoral versus Transapical Transcatheter Aortic Valve Implantation: Data from the VIenna transCaTheter aOrtic valve RegistrY (VICTORY)

Abstract 17539: Conventional vs. Transcatheter Aortic Valve Replacement - Propensity Score Adjusted Comparison of 3,751 Unselected Patients

Background and Hypothesis: Transcatheter aortic valve replacement (TAVR) is an established method in high-risk patients. Two aspects of this procedure are currently under discussion: 1.) Do the data acquired from randomized studies and registers justify expansion of the procedure to include younger and healthier patients? 2.) Is the transfemoral approach superior to the transapical approach with regard to mortality and periprocedural complications? Against this background we examined the mortality and morbidity of all patients who received an isolated conventional, transapical or transfemoral aortic valve replacement in accordance with the criteria of the Valve Academic Research Consortium (VARC)-2. Methods: A prospective register was taken from a single center recording all conventional (CONV, n=2,881), transapical (TAVR-TA, n=363) and transfemoral (TAVR-TF, n=570) aortic valve implantations during the period from 07/2009 to 10/2014. Using propensity score (PS) matching, first CONV and TAVRall (TA+TF) and then TAVR-TA and TAVR-TF were paired on the basis of 21 risk variables, creating comparable groups. Results: 393 pairs CONV vs. TAVRall within a moderate risk could be created (EuroSCORE 18.7 vs. 18.5; STS 5.0 vs. 5.4). Comparison revealed no difference for 30d mortality (4.6% CONV vs. 5.1% TAVRall, p=0.74), stroke (2.8% vs. 2.0%, p=0.48) or myocardial infarction (0.0 vs. 0.3%, p=0.50). Bleeding complications were significantly more frequent in the CONV, SM implantations and vascular complications in the TAVRall group. In the PS-adjusted comparison TAVR-TA vs. TAVR-TF (289 pairs; EuroSCORE 25.1 vs. 22.1; STS 6.8 vs. 6.7) there was also no difference in the hard endpoints (30d mortality 4.9% TA vs. 4.2% TF, p=0.70; stroke 3.1% vs. 2.8%, p=0.81; myocardial infarction 0.4% vs. 0.4%, p=1.00). Here bleeding complications were significantly more frequent in the TA group, SM implantations and vascular complications in the TF group. Subgroup analyses show an advantage of the TAVR procedure in patients with high STS or low LVEF. Conclusions: These data show that 1.) conventional aortic valve replacement and TAVR are comparable in the moderate risk group, and 2.) the two approaches, transapical and transfemoral, produce comparable results.

TCT-688 Acute, 30 and 90-day results of the STASIS trial: a multi-center study on a novel apical closure device for transapical transcatheter aortic valve implantation

Transapical access for transcatheter aortic valve implantation (TA-TAVI) has become a routine procedure for patients at high surgical risk and is a valid alternative to transfemoral TAVI. Transapical access has seen little standardization of technique due to the absence of automated preclosure and

Concomitant Transapical Transcatheter Valve Implantations: Edwards Sapien Valve for Severe Mitral Regurgitation in a Patient with Failing Mitral Bioprostheses and JenaValve for the Treatment of Pure Aortic Regurgitation

Transcatheter valve implantation is a novel interventional technique, which was developed as an alternative therapy for surgical aortic valve replacement in inoperable patients with severe aortic stenosis. Despite limited experience in using transcatheter valve implantation for mitral and aortic regurgitation, transapical transcatheter aortic valve implantation and valve-in-valve implantation for degenerated mitral valve bioprosthesis can be performed in high-risk patients who are not candidates for conventional replacement surgery. In this case, we present the simultaneous transcatheter valve implantation via transapical approach for both degenerated bioprosthetic mitral valve with severe regurgitation and pure severe aortic regurgitation.