Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS6. Survival After Transapical and Transarterial Aortic ValveImplantation: Talking About Two Different Patient PopulationsSabine Bleiziffer, Hendrik Ruge, Domenico Mazzitelli, Christian Schreiber,Andrea Hutter, Robert Bauernschmitt, Ruediger Lange *Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, GermanyInvited Discussant: Michael J. MackOBJECTIVE: Recently, suspicion rose that survival may be impaired after antegradetransapical valve implantation in high-risk patients with aortic stenosis comparedto the retrograde transarterial access. We analyzed survival in patients undergoingtranscatheter aortic valve implantation with regard to implantation technique.METHODS: Between 06/2007 and 09/2008, 153 high-risk patients (EuroScore24 ± 14%, mean age 81 ± 8 y) underwent transcatheter aortic valve implantationtransapically (n = 27) or transarterially (n = 123 transfemoral, n = 3 via subclavianartery). The transapical implantation technique was chosen only in patients whohad no access through diseased femoral or subclavian arteries.RESULTS: 30-day survival was 89.9% after transarterial vs 79.1% after transapicalimplantation (p = 0.028, see survival curve).The transapical group had a significantlyhigher preoperative BNP value, and a significantly higher incidence ofperipheral vessel and cerebrovascular disease, pulmonary hypertension, and atrioventricularvalve regurgitation. Death was valve-related in 25% (transapical) and29% (transarterial), cardiac in 13% and 10%, and non-cardiac in 63% and 62%,respectively (n.s.). In the transapical group, there were significantly less postoperativevascular complications (4% vs 20%, p = 0.009), and no neurological events (0% vs6.5%, n.s.).* AATS Member78