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Original Articles: Adult Cardiac

Transapical Aortic Valve Implantation: Therapy of Choice for Patients With Aortic Stenosis and Porcelain Aorta?

^a Clinic for Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany
^b Clinic for Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
^c Clinic for Radiology, University of Leipzig, Heart Center, Leipzig, Germany

Accepted for publication June 14, 2010.

^_* Address correspondence to Dr Walther, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstrasse 39,Leipzig, 04299, Germany (Email: walt{at}medizin.uni-leipzig.de).

Presented at the Poster Session of the Forty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 25–27, 2010.

Background: Conventional aortic valve replacement can be technically challenging in patients with porcelain aorta and is associated with a high rate of stroke and mortality. Porcelain aorta is even sometimes seen as contraindication for surgery. Minimally invasive off-pump transapical aortic valve implantation may be an optimal strategy to treat elderly patients with porcelain aorta requiring aortic valve replacement.

Methods: Twenty-nine patients with severe aortic stenosis and porcelain aorta underwent transapical aortic valve implantation. Mean age was 79 ± 7.8 years (range, 64 to 93 years), with 65.5% female. Logistic EuroSCORE and the Society of Thoracic Surgeons score were 37.7% ± 18.1% and 12.8% ± 2.2%, respectively. Peripheral vascular disease (41.4%) and carotid artery stenosis (58.6%) were frequent, and 17.2% of patients had experienced a stroke previously. The majority of patients were redo cases (51.2%), and 10.3% were dependent on chronic hemodialysis. In 13.8% of all patients, intraoperatively detected porcelain aorta caused an attempt at conventional aortic valve replacement by means of sternotomy to be aborted.

Results: All valves were implanted successfully without embolization or aortic dissection. All procedures were primarily performed off-pump, but 4 patients required secondary cardiopulmonary bypass as a result of complications. Median procedure time was 80 minutes, and median intensive care unit stay was 1 day. Stroke occurred in 1 patient only. Thirty-day mortality was 17.2%. Mild paravalvular leak was seen in 31.0%, and mild to moderate regurgitation occurred in 1 patient.

Conclusions: Transapical aortic valve implantation is a promising approach to treat elderly patients with porcelain aorta requiring aortic valve replacement. It is associated with acceptable outcome and low stroke rates.

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Invited Commentary

Gilbert H.L. Tang and Christopher M. Feindel
Ann. Thorac. Surg. 2010 90: 1461-1462. [Extract] [Full Text] [PDF]

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