Transaortic transcatheter aortic valve implantation: experience from the Kiel study.
To evaluate the efficacy and safety of Edwards SAPIEN-XT or SAPIEN-3 transcatheter heart valves via transaortic (TAo) access.



A total of 100 consecutive patients with severe symptomatic aortic stenosis undergoing TAo-transcatheter aortic valve implantation (TAVI) were included in this observational registry (November 2012-December 2014). Periprocedural and post-procedural outcomes were assessed.



Of these 100 patients, 1 received a Medtronic CoreValve. Therefore, this patient was subsequently removed from the analysis. Ninety-nine consecutive TAo-TAVI patients received a balloon-expandable transcatheter heart valve (Sapien). The SAPIEN-XT valve was implanted in 53 patients and the SAPIEN-3 valve in 46 patients. Fluoroscopy time was shorter in the SAPIEN-3 cases (5.6 ± 2.5 vs 8.1 ± 5.1 min, SAPIEN-XT; P = 0.004), with fewer patients requiring dilatation after the operation (20.5% SAPIEN-3 vs 64.2% SAPIEN-XT; P < 0.0001). There were no other significant differences in procedural characteristics between the two valves. All-cause 30-day mortality was 5.1% overall, with comparable outcomes for the two valves (5.7 and 4.4% for SAPIEN-XT and SAPIEN-3 valves, respectively; OR: 1.32; 95% CI: 0.21-8.27; P = 1.0). New atrial fibrillation (13.1%) and acute kidney injury (11.1%) were the most common complications during the 30 days post-procedure. The number of new pacemakers was low (6.1%), with no differences found between the two valve groups. A comparison of 100 TAo- and 42 TA-TAVI implanted in the same period demonstrated similar results in short- (P = 0.31) and long-term (P = 0.99) mortality rates.



The efficacy and safety of the Edwards SAPIEN-XT or SAPIEN-3 heart valves via TAo access were demonstrated by high procedural success and low complication rates. The data indicate that this approach is a viable alternative to established access routes.
Department for Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany rainer.petzina@uksh-kiel.de rainer.petzina@uksh.de.
Rainer
R
Petzina
Department for Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.|DZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Hamburg, Germany.
Georg
G
Lutter
Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Christin
C
Wolf
Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Constantin
C
Kühl
Department of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Sandra
S
Freitag-Wolf
Department for Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Bernd
B
Panholzer
Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
Peter
P
Bramlage
DZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Hamburg, Germany.|Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Norbert
N
Frey
Department for Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Jochen
J
Cremer
DZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Hamburg, Germany.|Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Campus Kiel, Germany.
Derk
D
Frank
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
Aortic valve replacement; SAPIEN; Transaortic access; Transcatheter aortic valve implantation; Transcatheter heart valve