title: Transapical aortic valve implantation - The Leipzig experience.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) represents a significant development in the treatment of high risk patients with aortic stenosis. As one of the first centers to perform transapical TAVI (taTAVI), we herein review our five-year experience with this technique.
  
  
  METHODS
  All patients undergoing taTAVI with an Edwards Sapien valve at the Leipzig Heart Center between 2006 and 2011 (n=439) were analysed. Data was drawn from a prospective database and retrospectively analysed. The learning curve was reviewed by means of descriptive statistics as well as cumulative sum failure analysis (CUSUM). All results are presented in compliance with Valve Academic Research Consortium (VARC) criteria.
  
  
  RESULTS
  The mean patient age was 81.5±6.4 years and 64.0% were female. The mean logistic EuroSCORE and STS risk of mortality were 29.7%±15.7% and 11.4%±7.6%, respectively. Procedural success was 90.2%. Stroke occurred in 2.1% of patients intra-operatively and a further 2.1% suffered stroke during their hospital stay. Mean transvalvular gradient was 9.0±3.9 mmHg and effective valve orifice area 1.3±0.6 cm(2). Moderate or greater aortic insufficiency was present in 5.7% of patients and remained stable during follow up. Overall survival was 90% at 30 days, 73% at 1 year, 68% at 2 years, 58% at 3 years, 53% at 4 years, and 44% at 5 years. CUSUM analysis revealed a definitive learning curve regarding the occurrence of major complications, with a progressive improvement after the initial 150 cases.
  
  
  CONCLUSIONS
  TaTAVI has become a routine approach for high risk patients with symptomatic severe aortic stenosis. Although taTAVI is a safe procedure with reproducible results, future research should focus on methods of reducing known complications and the associated learning curve for this procedure.
authors: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors: David M
authors: DM
authors: Holzhey
authors: Martin
authors: M
authors: Hänsig
authors: Thomas
authors: T
authors: Walther
authors: Joerg
authors: J
authors: Seeburger
authors: Martin
authors: M
authors: Misfeld
authors: Axel
authors: A
authors: Linke
authors: Michael A
authors: MA
authors: Borger
authors: Friedrich W
authors: FW
authors: Mohr
keywords: Transcatheter aortic valve implantation (TAVI); aortic stenosis; transapical TAVI (taTAVI)
references: Circulation. 2007 Sep 11;116(11 Suppl):I240-5
references: 17846311
references: J Am Coll Cardiol. 2010 Mar 16;55(11):1080-90
references: 20096533
references: Eur Heart J. 2011 Jan;32(2):198-204
references: 20864486
references: Circulation. 2006 Aug 8;114(6):591-6
references: 16880325
references: Eur J Cardiothorac Surg. 2012 Jun;41(6):1232-3
references: 22290888
references: Eur J Cardiothorac Surg. 2010 Aug;38(2):119-27
references: 20206542
references: Eur Heart J. 2011 Jan;32(2):205-17
references: 21216739
references: Circulation. 2011 Jan 25;123(3):299-308
references: 21220731
references: J Am Coll Cardiol. 2011 Nov 8;58(20):2130-8
references: 22019110
references: Ann Thorac Surg. 2009 Jan;87(1):276-83
references: 19101311
references: Circulation. 2011 Jul 26;124(4):425-33
references: 21747054
references: N Engl J Med. 2011 Jun 9;364(23):2187-98
references: 21639811
references: Eur Heart J. 2011 Jan;32(2):191-7
references: 20843959
references: Eur Heart J. 2010 Apr;31(7):865-74
references: 20037180
references: N Engl J Med. 2010 Oct 21;363(17):1597-607
references: 20961243
references: Catheter Cardiovasc Interv. 2011 Sep 1;78(3):457-67
references: 21563291
references: Nephrol Dial Transplant. 2009 Jul;24(7):2175-9
references: 19211648
references: Eur J Cardiothorac Surg. 2007 Jan;31(1):9-15
references: 17097302
references: J Thorac Cardiovasc Surg. 2007 Sep;134(3):663-9
references: 17723815
references: J Thorac Cardiovasc Surg. 2009 Nov;138(5):1073-80
references: 19765739
references: Circ Cardiovasc Interv. 2008 Dec;1(3):167-75
references: 20031675
references: Circulation. 2010 Jul 6;122(1):62-9
references: 20566953
references: EuroIntervention. 2011 May;7(1):41-8
references: 21550902