title: Transapical aortic valve implantation off-pump in patients with impaired left ventricular function.
abstract: BACKGROUND
  Patients with impaired left ventricular ejection fraction (LVEF) and severe aortic stenosis have a higher perioperative risk for aortic valve replacement. Transapical aortic valve implantation (TA-AVI) allows for off-pump valve implantation, which might be beneficial in the subgroup of patients with impaired LVEF.
  
  
  METHODS
  All patients with LVEF≤40% who underwent TA-AVI for severe aortic stenosis and who fulfilled at least 1-year follow-up formed the study group. Results were compared to TA-AVI patients with preserved LVEF treated during the same time period.
  
  
  RESULTS
  Thirty-nine patients with LVEF≤40% were identified, mean LVEF was 32.5±7.1%. Logistic EuroSCORE and STS-score were 43.6%±18.5% and 15.3%±9.3%, respectively. Concomitant coronary artery disease was present in 59% with 23.1% having had previous bypass surgery and 17.9% having had a history of prior myocardial infarction. Two patients required cardiopulmonary-bypass support due to intraoperative complications, and another 2 patients required cardiopulmonary-bypass for reperfusion. Median procedure time was 75 minutes (interquartile range, 65-90 minutes). LVEF at discharge increased significantly to a mean of 41.5%±10%, and at 1-year follow-up to 53.9%±13% (both p<0.0001). The proportion of patients in New York Heart Association class III-IV decreased from 92.3% to 15.0% at 1-year follow-up (p<0.001). There was neither a statistically significant difference in in-hospital mortality nor in long-term survival up to 4 years, in comparison to patients with preserved LVEF.
  
  
  CONCLUSIONS
  Transapical aortic valve implantation is a promising approach, allowing for off-pump treatment of elderly, high-risk patients with impaired LVEF requiring aortic valve replacement. Short-term and long-term outcomes are respectable, and an improvement in postoperative LVEF and New York Heart Association class can be anticipated.
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Arnaud
authors: A
authors: Van Linden
authors: Jörg
authors: J
authors: Kempfert
authors: Johannes
authors: J
authors: Blumenstein
authors: David
authors: D
authors: Holzhey
authors: Ardawan J
authors: AJ
authors: Rastan
authors: Friedrich W
authors: FW
authors: Mohr
authors: Thomas
authors: T
authors: Walther
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology