15 Years Results Of Transapical Trans Catheter Aortic Valve Replacement As An Alternative Approach In High Risk Patients:

BACKGROUND:we here intend to report our 15 years results of transapical tavr as a first line alternative approach in high risk patients deemd unsiutable for transfemoral pproach
METHODS: from 2008 and 2023 we submitted 222 high sugical risk patients (STS score 5.7 ± 1.1 Euroscore II 9.6 ± 2.3) to Transapical Transcatheter Aortic Valve Replacement (TAVR). At our Institution Transapical TAVR is the the first line alternative aproach to the transfemoral one. Patients were all deemd unsuitable for Transfemoral TAVR due to severe peripheral arterial occlusive disease by local Heart Team. All patients recieved a balloon expandable biological valve. All procedures were performed in cardiac surgery operating theater with a portable c-arm image intensyfier. Mean Age was 80 ± 3.5 years; 101 patients (45 %) were femeales; 68 (30 %) had a porcelain Aorta and 66 (33%) had been previously submitted to cardiac surgery
RESULTS: Postoperative mortality was 2% (5 patients); 2 patients suffered a perioperative stroke (0.9%). Intraprocedural complications occurrede in 4 patients (1.8%): 1 valve embolization in left ventricle that required surgical conversion, coronary artery occlusion in 1 case ( 0.45%), and in 2 cases left ventricular apex complications (0.9%). Median follow-up was 96 months and at 60 and 120 moths, the extimated rate of survival was 66% and 55% respectively
CONCLUSIONS: transapical transcatheter aortic valve replacement as an alternative approach to transfemoral one in high surgical risk elederly patients with severe peripheral artery occlusive disease, seems still safe and effective with accetable survival even in a lomg term period