title: A Decade of Transapical Aortic Valve Implantation.
abstract: BACKGROUND
  Transcatheter-based aortic valve procedures have undergone tremendous evolution during the past decade and have led to great changes in the treatment of valvular heart disease. The Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany is one of the three pioneering centers that started performing transapical transcatheter aortic valve implantation (TA-TAVI) back in 2005, and this study reviews the 10-year institutional experience with this approach.
  
  
  METHODS
  From January 2005 through January 2015, 312 consecutive high-risk patients underwent TA-TAVI. Echocardiographic follow-up at discharge, at 6 and 12 months, and yearly thereafter was 100% complete. Structural behavior of the balloon-expandable valves in 11 patients with a mean follow-up time beyond 8 years was additionally evaluated at latest follow-up using computed tomography measurements.
  
  
  RESULTS
  The age of the patients in this study was 79.8 ± 5.8 years, and the mean logistic EuroSCORE II and The Society of Thoracic Surgeons score were 23.9% ± 17.2% and 9.8% ± 8.6%, respectively. Perioperative, 30-day, and in-hospital mortality rates were 1.3%, 8.2%, and 9.5%, respectively, with a decrease in 30-day mortality to 4.2% in 2014. The incidence of neurologic complications was 3.2%. Mean length of hospital stay was 8.7 ± 4.3 days. Echocardiographic results demonstrated a significant and persistent increase of effective aortic valve orifice area (preoperative: 0.69 ± 0.1 cm(2) vs. late-follow-up: 1.52 ± 0.2 cm(2); p = 0.04) and a decrease in mean transvalvular gradient (preoperative: 49.5 ± 8.2 mm Hg vs. late-follow-up: 13.8 ± 4.3 mm Hg; p = 0.03) after a mean follow-up time of 4.1 ± 2.3 years. Overall survival rates were 73% ± 2% and 56% ± 6% at 3 and 5 years, respectively. Computed tomography measurements have not shown any signs of stress fracture of balloon-expandable stents up to 8 years of follow-up.
  
  
  CONCLUSIONS
  A decade after clinical introduction of TA-TAVI, procedural and technical advances have made it an established alternative to classic aortic valve replacement in high-risk patients with aortic valve stenosis. Despite limited worldwide data on hemodynamic and structural valve behavior beyond 8 years, 11 patients from our early experience who were followed up for 8 years in the current report did not have any signs of structural valve dysfunction.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. Electronic address: nestoras.papadopoulos@kgu.de.
authors.forename: Nestoras
authors.initials: N
authors.lastname: Papadopoulos
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Wenzel
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Marlene
authors.initials: M
authors.lastname: Thudt
authors.affiliation: Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.affiliation: Department for Cardiothoracic Surgery, Heart and Vessel Center, Bad Bevensen, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.affiliation: Division of Cardiology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Seeger
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: El-Sayed Ahmad
authors.affiliation: Division of Cardiology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Fichtlscherer
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D059032:Learning Curve; D008297:Male; D009017:Morbidity; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods* / Q000401:mortality