Medium Term Outcomes of Transapical Aortic Valve Implantation: Results From the Italian Registry of Trans-Apical Aortic Valve Implantation

• DOI: 10.1016/j.athoracsur.2013.04.094
• Publication Date: 2013-07-16T12:46:12Z
• Authors: Augusto D'Onofrio; Stefano Salizzoni; Marco Agrifoglio; Linda Cota; Giampaolo Luzi; Paolo M. Tartara; Giovanni D. Cresce; Marco Aiello; Carlo Savini; Mauro Cassese; Alfredo Cerillo; Giuseppe Punta; Micaela Cioni; Davide Gabbieri; Chiara Zanchettin; Andrea Agostinelli; Enzo Mazzaro; Omar Di Gregorio; Giuseppe Gatti; Giuseppe Faggian; Claudia Filippini; Mauro Rinaldi; Gino Gerosa
• Keywords: Male; Cardiac Catheterization; 610; Kaplan-Meier Estimate; 03 medical and health sciences; 0302 clinical medicine; Humans; surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Humans, Italy; Hospital Mortality; Prospective Studies; Aged; Proportional Hazards Models; Aged, 80 and over; Heart Valve Prosthesis Implantation; Endovascular Procedures; Age Factors; Aortic Valve Stenosis; 3. Good health; Settore MEDS-13/C - Chirurgia cardiaca; Settore MED/23; Logistic Models; Italy; Echocardiography; Heart Valve Prosthesis; Multivariate Analysis; Female; Follow-Up Studies

Transcatheter aortic valve implantation (TAVI) has been proposed as a therapeutic option for high-risk or inoperable patients with severe symptomatic aortic valve stenosis. The aim of this multicenter study was to assess early and medium term outcomes of transapical aortic valve implantation (TA-TAVI).From April 2008 through June 2012, a total of 774 patients were enrolled in the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). Twenty-one centers were included in the I-TA registry. Outcomes were also analyzed according to the impact of the learning curve (first 50% cases versus second 50% cases of each center) and of the procedural volume (high-volume versus low-volume centers).Mean age was 81.0±6.7 years, mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) I, EuroSCORE II, and The Society of Thoracic Surgeons risk score were 25.6%±16.3%, 9.4%±11.0%, and 10.6%±8.5%, respectively. Median follow-up was 12 months (range, 1 to 44). Thirty-day mortality was 9.9% (77 patients). Overall 1-, 2-, and 3-year survival was 81.7%±1.5%, 76.1%±1.9%, and 67.6%±3.2%, respectively. Thirty-day mortality of the first 50% patients of each center was higher when compared with the second half (p=0.04) but 3-year survival was not different (p=0.64). Conversely, 30-day mortality at low-volume centers versus high-volume centers was similar (p=0.22). At discharge, peak and mean transprosthetic gradients were 21.0±10.3 mm Hg and 10.2±4.1 mm Hg, respectively. These values remained stable 12 and 24 months after surgery.Transapical TAVI provides good results in terms of early and midterm clinical and hemodynamic outcomes. Thus it appears to be a safe and effective alternative treatment for patients who are inoperable or have high surgical risk.