Introduction Aortic valve replacement is the only effective treatment for aortic stenosis. Transcatheter aortic valve implantation (TAVI) is an innovative approach for high-risk elderly patients.
Methods 80 patients (mean age 84 ± 7 years) with severe aortic stenosis underwent TAVI with the Edwards Lifesciences Sapien bioprosthesis using a transapical (n = 48; 60%) or transfemoral (n = 32; 40%) approach from August 2007. The mean ejection fraction was 50 ± 11%, with maximum peak gradient 84 ± 24 mm Hg, mean peak gradient 52 ± 15 mm Hg and a mean aortic valve orifice area of 0.57 ± 0.15 cm2. The transapical approach was used in patients with peripheral vessel disease and poor vascular access. All patients had high risk for conventional surgery as evidenced by logistic Euroscore (21.6 ± 11.6%) or the presence of a porcelain aorta (n = 16). 65% of all patients were in NYHA class III or IV.
Results All TAVI were performed in the catheter laboratory under general anaesthesia (n = 79) or thoracic epidural anaesthesia (n = 1). The valves were sized based on aortic valve annulus: 23 mm (n = 37) or 26 mm (n = 43). Procedural success was achieved in 99% (one patient required conversion from transfemoral to transapical). Only one (1.2%) patient had aortic regurgitation of grade II or greater and two (2.5%) patients required emergency cardiopulmonary bypass. Postprocedural mean and peak gradients were 5.1 ± 4 mm Hg and 9.8 ± 6 mm Hg, respectively. Postoperative complications included stroke (2.5%), complete arteriovenous block (2.5%), renal failure (10%) and major vascular complications (8%). The overall 30-day mortality was 10% (n = 8). At the time of analysis with a median follow-up of 19.5 weeks (range 1–64 weeks) 64 patients (80%) were alive.
Conclusion TAVI is a feasible treatment option for severe aortic stenosis for high-risk surgical patients, with excellent short-term results and very promising medium-term results.