title: Transapical aortic valve implantation: The Vancouver experience.
abstract: BACKGROUND
  Off-pump transapical aortic valve implantation (TA-TAVI) through mini-thoracotomy was first performed in Vancouver, Canada in October 2005. The objective of this manuscript is to describe the Vancouver experience with 178 TA-TAVI cases in symptomatic severe aortic stenosis (AS) since 2005.
  
  
  METHODS
  Baseline characteristics and in-hospital outcomes were calculated for the overall cohort. To compare pre-procedure and post-procedure echocardiographic measurements, one way analysis of variance was utilized, followed by Tukey's HSD. In-hospital outcomes were compared between early and late cohorts using Z-test and chi-squared test as appropriate. Kaplan-Meier analysis was used to generate 3-year survival curves. The Log-rank test was used to compare survival between low-risk and high-risk groups, based on STS score.
  
  
  RESULTS
  Between October 2005-March 2012, TA-TAVI was performed in 178 patients. Mean age was 80.5±8.6 years. Congestive heart failure and renal failure were more common in the late cohort, while previous myocardial infarction was more common in the early cohort (P<0.05). Eleven patients (6.2%) had significant intra-operative complications, including death (1.7%), conversion to CPB (3.9%), and valve embolization (1.1%). In-hospital survival was 87.9%. Mean length of hospital stay was 12.2±17.1 days. In-hospital incidence of stroke was 3.4%. Bleeding (20.2% vs. 4.7%) and vascular (14.6% vs. 3.5%) complications were more common in the early cohort. Echocardiography demonstrated a significant increase in aortic valve area and decrease in mean transvalvular gradient post-procedure. These improvements were maintained throughout the 3-year follow-up period. Overall survival was 72.1% at 6 months, 67.7% at 12 months, 55.5% at 24 months, and 47.3% at 36 months. Repeated Kaplan-Meier analysis for the 2 groups stratified by STS score, demonstrated improved survival in the low-risk group (Log-rank P=0.039).
  
  
  CONCLUSIONS
  Among patients with symptomatic severe AS at high risk for conventional AVR, TA-TAVI is a reasonable therapeutic option with acceptable risk. Long-term survival appears to be superior in lower-risk patients.
authors: Division of Cardiovascular Surgery.
authors: Jennifer
authors: J
authors: Higgins
authors: Jian
authors: J
authors: Ye
authors: Stefan
authors: S
authors: Toggweiler
authors: John G
authors: JG
authors: Webb
authors: Anson
authors: A
authors: Cheung
keywords: Transapical aortic valve implantation (TA-TAVI); aortic stenosis (AS)
references: Eur J Cardiothorac Surg. 2007 Jan;31(1):16-21
references: 17126558
references: J Thorac Cardiovasc Surg. 2010 May;139(5):1107-13, 1113.e1
references: 20412948
references: J Thorac Cardiovasc Surg. 2011 Aug;142(2):e47-52
references: 21592530
references: Circulation. 2006 Aug 8;114(6):591-6
references: 16880325
references: J Thorac Cardiovasc Surg. 2009 Jan;137(1):167-73
references: 19154921
references: J Am Coll Cardiol. 2011 Jan 18;57(3):253-69
references: 21216553
references: J Thorac Cardiovasc Surg. 2006 May;131(5):1194-6
references: 16678621
references: J Am Coll Cardiol. 2012 Apr 3;59(14):1287-94
references: 22365423
references: N Engl J Med. 2011 Jun 9;364(23):2187-98
references: 21639811