title: Transaortic aortic valve replacement using the Edwards Sapien-XT Valve and the Medtronic CoreValve: initial experience.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) is now an established treatment for certain patients with severe aortic valve stenosis (AS). However, as the number of patients screened for TAVR increases, many are found to have absolutely no option for peripheral artery access. Transaortic valve replacement (TAoVR) has been proposed as a new alternative route in patients deemed unsuitable for conventional approaches. We present our first series of TAoVR cases using the Edwards Sapien-XT and the Medtronic CoreValve prostheses.
  
  
  METHODS
  Twenty-five (25) symptomatic patients (mean age 78 ± 8 years, mean logistic EuroSCORE I 25 ± 11%) with severe AS underwent TAoVR using the Sapien-XT valve (10 patients) or the CoreValve (15 patients).
  
  
  RESULTS
  The mean fluoroscopy time was 15.6 ± 4.2 minutes, the mean time in the intensive care unit was 1.9 ± 1.0 days, and the mean hospital stay was 6.4 ± 1.6 days. The mean effective aortic valve area increased (from 0.68 ± 0.15 cm(2) to 1.82 ± 0.34 cm(2), p<0.001) and the mean transvalvular pressure gradient declined (from 48 ± 15 mmHg to 9 ± 5 mmHg, p<0.05) post implantation. The procedural mortality was 0% and the in-hospital mortality was 4% (one death at day 3 due to cardiogenic shock). The mean NYHA functional class improved from 3.2 ± 0.4 to 1.5 ± 0.9 at 30 days.
  
  
  CONCLUSIONS
  Our initial experience with the TAoVR approach using both the Edwards Sapien-XT and the Medtronic CoreValve prosthesis demonstrated that it could be performed safely, resulting in substantial acute echocardiographic and early clinical improvement.
authors.affiliation: Departments of Transcatheter Heart Valves, Hygeia Hospital, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spargias
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bouboulis
authors.forename: Antonios
authors.initials: A
authors.lastname: Halapas
authors.forename: Michael
authors.initials: M
authors.lastname: Chrissoheris
authors.forename: Spyridon
authors.initials: S
authors.lastname: Skardoutsos
authors.forename: Joulia
authors.initials: J
authors.lastname: Nikolaou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsolakis
authors.forename: Christos
authors.initials: C
authors.lastname: Mourmouris
authors.forename: Stratis
authors.initials: S
authors.lastname: Pattakos
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome