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Transapical aortic valves: work in progress
Transapical beating heart aortic valve implantation (TAP-AVI) has recently shown promise as a minimally invasive method of treating aortic stenosis in patients who are considered too high-risk for surgery. Walther et al analysed the results of the initial 50 patients receiving TAP-AVI at their centre in Leipzig, Germany.
Of the 50 patients, 47 (94%) successfully underwent TAP-AVI using rapid ventricular pacing. No complications such as embolisation or migration of the valve prosthesis occurred, but three patients required conversion to open surgery, one of whom died on day 125 owing to complications of a comorbid illness. Actuarial survival at 1 month, 6 months and 1 year was 92%, 73.9% and 71.4%, respectively.
These results are encouraging given the recent publication of a US study which found a much lower survival rate of 81.8% at 1 month, leading some to suggest that TAP-AVI is potentially not as safe as transfemoral aortic valve replacement. Both techniques are being tested in one arm of the current PARTNER (Placement of AoRtic TraNscathetER valve) trial, designed to show non-inferiority of transcatheter approaches compared with traditional surgery. A second arm of the trial aims to show that transfemoral aortic valve replacement is better than medical treatment in patients who are too high-risk for surgery. As with so many contemporary medical treatments, patient selection is the most critical factor when considering transcatheter valve replacement, and it is hoped that the PARTNER trial will help to answer many questions in this regard.
▸ Walther T, Falk V, Kempfert J, . Transapical minimally invasive aortic valve implantation; the initial 50 patients. Eur J Cardiothorac Surg 2008;33:983–8.
▸ Svensson LG, Dewey T, Kapadia S, . United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann Thorac Surg 2008;86:46–54.
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