Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience

Giuseppe Bruschi, Federico De Marco, Luca Botta, Alberto Barosi, Paola Colombo, Silvia Mauri, Aldo Cannata, Nuccia Morici, Tiziano Colombo, Pasquale Fratto, Sandra Nonini, Francesco Soriano, Michele Mondino, Cristina Giannattasio, Silvio Klugmann

Research output: Contribution to journalArticle

Abstract

Objective Transcatheter aortic valve implantation (TAVI) has been designed to treat elderly patients with severe aortic stenosis at high risk for surgery. These patients are also often affected by severe iliac-femoral arteriopathy, rendering the trans-femoral approach unusable. We report our experience with the direct-aortic approach to treat these patients. Methods From May 2008 to November 2013 two hundred and thirty-two patients (131 female, 56%) with severe symptomatic aortic stenosis and no reasonable surgical option due to excessive risk were evaluated for TAVI at our department. Of these patients, 202 were deemed eligible for TAVI. Of this group, 50 underwent CoreValve implantation by the direct aortic approach through a right anterior mini-thoracotmy (28 female, 56%), mean age 81.2 ± 6.9. A combined team of cardiologists, cardiac surgeons with expertise in hybrid procedures, and anesthetists performed all the procedures. Results Twenty-eight (56%) patients were female and 11 (22%) were redo at TAVI. We used a 23-mm CoreValve Evolute in 3 patients (6%), and the most used valve size was the 29 mm in 46% of patients. Mean hemodynamic trans-aortic gradient was less than 5 mm Hg. The paravalvular regurgitation was ≤ grade 1 in 46 patients as assessed by peri-procedural transesophageal echocardiography (TEE). Seven patients (7/43, 16%) required a permanent pacemaker implantation; 30-day mortality was 6% (3 patients). Seven patients (14.8%) died during follow-up. Actuarial survival at 2 years is 84.7 ± 5.3%. Conclusions Transcatheter aortic valve implantation with the direct aortic approach is safe and feasible, offering a new attractive option to treat selected high-risk patients with severe aortic stenosis and peripheral vasculopathy, including those requiring a re-do procedure.

Original languageEnglish
Pages (from-to)437-442
Number of pages6
JournalInternational Journal of Cardiology
Volume181
DOIs
Publication statusPublished - Feb 15 2015

Keywords

  • Aortic stenosis
  • Aortic valve
  • Minimally invasive surgery
  • Thoracotomy
  • Transcatheter valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Bruschi, G., De Marco, F., Botta, L., Barosi, A., Colombo, P., Mauri, S., Cannata, A., Morici, N., Colombo, T., Fratto, P., Nonini, S., Soriano, F., Mondino, M., Giannattasio, C., & Klugmann, S. (2015). Right anterior mini-thoracotomy direct aortic self-expanding trans-catheter aortic valve implantation: A single center experience. International Journal of Cardiology, 181, 437-442. https://doi.org/10.1016/j.ijcard.2014.11.108