title: Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis.
abstract: OBJECTIVE
  Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication. Minimally invasive transcatheter aortic valve implantation has emerged as an alternative, with lower morbidity and mortality. The aim of this study was clinical, safety and efficacy assessment.
  
  
  METHODS
  Thirty-three high risk patients underwent transcatheter balloon expandable aortic valve implantation. Mean Logistic EuroScore risk was 39.30% and STS score 30.28%. Eight patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis were implanted trough the ventricular apex under rapid ventricular pacing or hemorrhagic shock. Echocardiographic and angiographic controls were performed.
  
  
  RESULTS
  Implant was feasible in 30 cases. Three conversions occured. There was only one case of operative death. Median transvalvular aortic gradient reduced from 43.58 mmHg to 10.54 mmHg. Left ventricular function improved in the first 7 postoperative days. Paravalvular aortic regurgitation was mild and present in 30.30%. One case presented major vascular complication and another one permanent pacemaker implant. One major stroke case occurred. Overall 30-day mortality was 18.18%.
  
  
  CONCLUSIONS
  The transapical implantation of catheter mounted bioprosthesis is a safe procedure with acceptable midterm results. Long term follow-up with increased sample power is mandatory in order to access hemodynamic, life quality and survival.
authors.affiliation: UNIFESP, São Paulo, Brasil. 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: Marcus Vinícius
authors.initials: MV
authors.lastname: Gimenes
authors.forename: Murilo Teixeira
authors.initials: MT
authors.lastname: Macedo
authors.forename: Márcio Rodrigo
authors.initials: MR
authors.lastname: Martins
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D001938:Brazil; D002114:Calcinosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome