Transapical aortic valve implantation: therapy of choice for patients with aortic stenosis and porcelain aorta?
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.
Clinic for Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
Jörg
J
Kempfert
Arnaud
A
Van Linden
Axel
A
Linke
Gerhard
G
Schuler
Ardawan
A
Rastan
Sven
S
Lehmann
Lucas
L
Lehmkuhl
Friedrich-Wilhelm
FW
Mohr
Thomas
T
Walther
D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002114:Calcinosis / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged