Boston - American Association for Thoracic Surgery

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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 <strong>for</strong> Cardiovascular <strong>Surgery</strong>, 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
AMERICAN ASSOCIATION FOR THORACIC SURGERYCONCLUSION: Survival is worse in patients in whom transapical, as opposed totransarterial aortic valve implantation is necessary, because these patients exhibit asignificantly higher incidence of comorbidities. The causes of death were not differentin the two groups, however, more patients in the transapical group succumbduring follow-up. On the other hand, cerebrovascular complications did not occurin patients with transapical access.11:25 a.m. PRESIDENTIAL ADDRESSThe Quality ConundrumThomas L. Spray, MD, Philadelphia, PAIntroduced By: Alec Patterson, MD12:15 p.m. LUNCH – VISIT EXHIBITSExhibit HallCARDIOTHORACIC RESIDENTS’ LUNCHEON*Room 311, Hynes Convention Center*Ticketed eventMONDAYMorning79
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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