title: Transapical minimally invasive aortic valve implantation: multicenter experience.
abstract: BACKGROUND
  To evaluate initial multicenter results with minimally invasive transapical aortic valve implantation (TAP-AVI) for high risk patients with aortic stenosis.
  
  
  RESULTS
  TAP-AVI was performed via a small anterolateral minithoracotomy with or without femoro-femoral extracorporeal circulation (ECC) on the beating heart. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN THV, Edwards Lifesciences) was used. Fifty-nine consecutive patients (81+/-6 years, 44 female) were operated on from 02/06 until 10/06 at 4 centers using fluoroscopic and echocardiographic visualization. Average EuroSCORE predicted risk for mortality was 27+/-14%. TAP valve positioning was performed successfully in 53 patients, 4 required early conversion to sternotomy. Implantation (23-mm valves in 19 and 26-mm valves in 40 patients) was performed on the beating heart during brief periods of rapid ventricular pacing. Thirty-one patients were operated on without cardiopulmonary bypass. Neither coronary artery obstruction nor migration of the prosthesis was observed, and all valves had good hemodynamic function. Echocardiography revealed minor paravalvular leakage in 26 patients (trace in 11, mild in 12, and severe in 3). Eight patients died in-hospital (13.6%) without any valve dysfunction. Actuarial survival was 75.7+/-5.9% at a follow-up interval of 110+/-77 days (range 1 to 255 days).
  
  
  CONCLUSIONS
  TAP-AVI can be performed safely with good early results in high risk patients. Long-term valve performance as well as broader based applications of this promising approach will need to be studied.
authors.affiliation: University Leipzig, Heartcenter, Department of Cardiac Surgery, Leipzig, Germany. walt@medizin.uni-leipzig.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Paul
authors.initials: P
authors.lastname: Simon
authors.forename: Todd
authors.initials: T
authors.lastname: Dewey
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Marie T
authors.initials: MT
authors.lastname: Kasimir
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Fehske
authors.forename: Ernst
authors.initials: E
authors.lastname: Wolner
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Michael
authors.initials: M
authors.lastname: Mack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D002417:Cattle; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D011474:Prosthesis Design / Q000295:instrumentation / Q000379:methods / Q000639:trends