Direct aortic transcatheter aortic valve implantation, a promising new approach

ObjectiveThe transcatheter aortic valve implantation (TAVI) is an established therapy option for high risk patients with severe aortic valve stenosis. The peripheral arterial (Femoral or Subclavien) and the minimal invasive surgical access via Apex are the standard access routes. Out come and prognosis of TAVI is determined by the peripheral vessel complications, strokes, paravalvular leak and apical cardiac infarction. The direct aortic (DA) approaches is a new alternative for the minimal invasive surgical TAVI access. We report our experience and discuss the different aspects this technique.MethodsBetween September 2011 and August 2012 we performed in 50 patients DA-TAVI via partial upper sternotomy with the self expanding Medtronic CorValve bioprothesis. From the tenth patient DA was the primary access route for TAVI. The Procedure is done in general anesthesia and performed by an interventional heart team in the operating room (OR). The fast-track anesthesia with immediate extubation after the procedure in the OR was established after the tenth patient.ResultsThe mean patients age was 78±5,2years and 52% were male. The mean logistic EuroSCORE were 20,3±10,8. Coronary artery disease were documented in 30 (60%) patients, including eight re-do procedures. In 15 (30%) cases were severe peripheral vasculopathy the main indication for DA access. Procedural success was 100%. Mean aortic gradient dropped immediately under 5 mm Hg, end diastolic left ventricle pressure improved on average by 30% in all patients and there was no vascular complications. Stroke occurred in one patient. 5 patients had, during the first days after the procedure, a psycho-organic syndrome, where a stroke was excluded. The post-operative echocardiogram demonstrated in 45 (90%) patients non to trace, in 4 (8%) patients mild and in 1(2%) patient moderate aortic regurgitation.ConclusionDirect aortic access for TAVI is a surgical simple, flexible and safe approach to treat high risk patients with symptomatic aortic stenosis and might enrich the surgical TAVI access with a new promising approach