Transaortic transcatheter aortic valve implantation using edwards sapien valve

A Novel Approach

Authors

  • Vinayak Bapat FCRS, CTh,

    Corresponding author
    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
    • Department of Cardiothoracic Surgery, 6th Floor East Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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  • Muhammed Z. Khawaja MBBS,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Rizwan Attia MBChB,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Ashok Narayana MBBS,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Karen Wilson BSc,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Kirsty Macgillivray BSc,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Christopher Young MD,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Jane Hancock PhD,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Simon Redwood MD,

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Martyn Thomas MD

    1. Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
    2. Department of Cardiology, Guy's and St. Thomas' Hospital, London, United Kingdom
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  • Conflict of interest: Dr. Bapat, Dr. Young, Dr. Thomas and Dr. Redwood are Proctors for Edwards Lifescisnces for the TAVI procedure.

Abstract

Objectives: To evaluate feasibility and outcome of Transoartic Transcatheter Sapien valve implantation. Background: Transcatheter Aortic valve implantation (TAVI) using the Edwards SAPIEN device (Edwards LifeScience, Irvine, CA) is usually performed via the transfemoral (TF) or transapical (TA) routes. Some patients are not suitable for these approaches. We report our experience with the novel transaortic (TAo) approach via a partial upper sternotomy and discuss the advantages and future applications. Methods: Between January 2008 to March 2011 193 patients with severe aortic stenosis underwent TAVI with the Edwards SAPIEN bioprosthesis at the St. Thomas' Hospital, London. 108 patients were unable to undergo a TF-TAVI and of those 17 were accepted for a TAo-TAVI on the basis of anatomy, risk, LV function, and significant respiratory disease. Results: The TAo-TAVI group (n = 17) had more prevalent respiratory disease than the TA-TAVI group (47.0% vs. 18.7%, P = 0.011). Otherwise the groups were similar in demographics and history. Despite this the 30 day mortalities were not significantly different between the groups (TAo-TAVI 4.3% at 30 days versus TA-TAVI 7.7%, P = 0.670). There were no significant differences in procedural complications. Conclusions: The TA-TAVI approach may not be desirable in patients with severe chest deformity, poor lung function or poor left ventricular function. TAo-TAVI via a partial sternotomy is safe and feasible in these patients. © 2011 Wiley Periodicals, Inc.

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