Objectives: Transcatheter aortic valve implantation using the Edwards Sapien pericardial vale is performed in high-risk patients in our center. Severe femoral artery calcifications can impede transfermoral sheath placement. In those patients transapical valve placement is performed. In this study, we compare efficacy and safety of both approaches.
Methods: Outcome of 38 consecutive patients was recorded with regard to procedural success, patient survival, and morbidity (groupe A: transfemoral 22 patients, group B: transapical 16 patients). Preoperative CT scan of the groin vessels was used to decide on transfermoral or transapical implantation. Patient age was similar in both groups (86 vs 83years). Mean preoperative aortic gradients were lower in the transfermoral group (40±13 vs 45±17 mmHg). Operative risk-scores were significantly lower in the transfemoral group (Log. Eurscore 43 % vs 35 %). Mean operation time was 92 +/- 22 min (transfemoral) and 85 +/- 17 min (transapical).
Results: Transcatheter valve implantations showed similar postprocedural Results in both groups. No patient showed significant aortic regurgitation. Postimplant gradients were similar (16/9 vs 15/8 mmHg max/mean). There were no periprocedural deaths. At 30 days and 6 months, patient survival was respectively 95 % vs 92% in the transfemoral and 81 % vs 81% in the transapical group. For patients in the transfemoral group showed significant vascular complications. Two patients in both groups showed arrhythmia complications. No patients suffered from postoperative stroke. Valve performance was good in both groups at follow-up.
Conclusions: Minimally invasive transcatheter aortic valve placement is safe and efficacious in patients with high surgical risk. Preoperative femoral artery CT scan helps to choose the correct approach for each patient.