title: Transcatheter aortic valve implantation using transfemoral/transsubclavian or transapical approach: 30-day follow-up of the initial 30 patients.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS).
  
  
  OBJECTIVE
  To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement.
  
  
  METHODS
  Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory.
  
  
  RESULTS
  Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03).
  
  
  CONCLUSIONS
  Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.
authors.affiliation: 1Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.forename: Maciej
authors.initials: M
authors.lastname: Dąbrowski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Chmielak
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.forename: Janina
authors.initials: J
authors.lastname: Stępińska
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Juraszyński
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuśmierski
authors.forename: Piotr
authors.initials: P
authors.lastname: Michałek
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Mirosław
authors.initials: M
authors.lastname: Dziekiewicz
authors.forename: Ewa
authors.initials: E
authors.lastname: Sitkowska-Rysiak
authors.forename: Piotr
authors.initials: P
authors.lastname: Wolski
authors.forename: Ewa
authors.initials: E
authors.lastname: Księżycka
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Czerwińska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
authors.forename: Stefania Lidia
authors.initials: SL
authors.lastname: Chojnowska
authors.forename: Witold
authors.initials: W
authors.lastname: Rużyłło
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome