title: Transapical aortic valve implantation in patients with severely depressed left ventricular function.
abstract: OBJECTIVE
  Transapical aortic valve implantation significantly reduces operative risk in elderly patients with aortic valve stenosis and comorbidities. However, it is unknown whether this procedure is feasible in patients with advanced heart failure.
  
  
  METHODS
  Between April 2008 and July 2010, 258 patients underwent transapical aortic valve implantation. Twenty-one patients had advanced heart failure with decompensation and a left ventricular ejection fraction of 10% to 25%. The mean age of these patients was 74 ± 11 years (range, 36-88 years). The mean left ventricular ejection fraction was 20% ± 5% (range, 10%-25%). Mean logistic EuroSCORE was 66% ± 21% (range, 27%-97%) and mean Society of Thoracic Surgeons score 33% ± 25% (range, 4%-90%). Nine patients were operated on using femorofemoral cardiopulmonary bypass and 12 without.
  
  
  RESULTS
  Technical success of the procedure was 100% with no conversion to conventional surgery. The mean time of cardiopulmonary bypass was 27 ± 25 minutes (range, 6-81 minutes). Postoperatively, the left ventricular ejection fraction increased to 38% ± 12% (range, 20%-60%). There were no postoperative neurologic complications. A new pacemaker implantation was needed in 2 (10%) patients. The 30-day mortality was 4.8%. Survival at 1, 3, 12, and 24 months was 95%, 81%, 76%, and 62%, respectively.
  
  
  CONCLUSIONS
  Transapical aortic valve implantation can be performed safely in patients with decompensated heart failure or even in the presence of cardiogenic shock.
authors.affiliation: Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Unbehaun
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreysse
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left