title: Transaortic Transcatheter Aortic Valve Implantation as a Second Choice over the Transapical Access.
abstract: OBJECTIVE
  In this report, we present our experience with the transaortic transcatheter aortic valve implantation using the SAPIEN valve. The procedural success, 30-day outcome, and survival up to 2 years are compared with the transapical access performed in patients in our institution.
  
  
  METHODS
  Of a total of 282 transcatheter aortic valve implantation patients, 100 consecutive patients had a non-transfemoral approach. The transaortic and transapical access routes were used in 36 and 64 patients, respectively. The transaortic group had a higher mean logistic EuroSCORE (32.6 vs 25.2, p = 0.021) and more patients with left ventricular ejection fraction less than 40% (33.3% vs 14.1%, p = 0.023).
  
  
  RESULTS
  The respective technical success rates for the transaortic and transapical groups were 100% and 95.2% (p = NS). There were significantly more perioperative hemodynamic problems necessitating cardiopulmonary resuscitation or mechanical circulatory support in the transapical group (18.8% vs 2.8%, p = 0.023). The transaortic group had a slightly shorter hospital stay (7 vs 8 days, p = 0.018). The 30-day mortality was 8.6% and 10.9% in the transaortic and transapical group, respectively (p = NS). Combined safety outcome was similar in both groups at 30 days. The respective 1-year survival rates for the transaortic and transapical groups were 71.5% and 68.3%, respectively (p = NS).
  
  
  CONCLUSIONS
  The trans transcatheter aortic valve implantation is a considerable choice to transapical approach. Despite a higher risk patient cohort, the clinical outcome is at least comparable to the transapical transcatheter aortic valve implantation, and it can be utilized as a second choice for patients with prohibitive iliac-femoral anatomy for transfemoral access.
authors: Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: J
authors: J
authors: Ropponen
authors: Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: T
authors: T
authors: Vainikka
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: J
authors: J
authors: Sinisalo
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: J
authors: J
authors: Rapola
authors: Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors: M
authors: M
authors: Laine
authors: Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland leo.ihlberg@hus.fi.
authors: L
authors: L
authors: Ihlberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Heart diseases; aortic valve stenosis; cardiac valve prosthesis; heart surgical procedure; minimally invasive surgical procedures; transcatheter aortic valve implantation