title: Transapical aortic valve implantation: results of a Brazilian prosthesis.
abstract: OBJECTIVE
  The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant.
  
  
  METHODS
  After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU.
  
  
  RESULTS
  Implant was feasible in 13 cases. There were no intra-operative deaths. Median peak transvalvular aortic gradient reduced to 25.0 mmHg, and left ventricular function improved in the first seven post-operative days. Paravalvular aortic regurgitation was mild and present in 71%. No definitive pacemaker was needed. There was no peripheral vascular complication. Overall mortality was 42%.
  
  
  CONCLUSIONS
  The transapical implantation of cathetermounted bioprosthesis was a feasible procedure. Long term follow-up is mandatory in order to access efficacy and indications.
authors.affiliation: UNIFESP. drgaia@terra.com.br
authors.forename: Diego Felipe
authors.initials: DF
authors.lastname: Gaia
authors.forename: José Honório
authors.initials: JH
authors.lastname: Palma
authors.forename: Carolina Baeta Neves Duarte
authors.initials: CB
authors.lastname: Ferreira
authors.forename: José Augusto Marcondes de
authors.initials: JA
authors.lastname: Souza
authors.forename: Guilherme
authors.initials: G
authors.lastname: Agreli
authors.forename: José Cícero Stocco
authors.initials: JC
authors.lastname: Guilhen
authors.forename: André
authors.initials: A
authors.lastname: Telis
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001027:Aortography; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome