Transapical aortic valve implantation in patients with severely depressed left ventricular function Axel Unbehaun, MD, Miralem Pasic, MD, PhD, Semih.

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Presentation transcript:

Transapical aortic valve implantation in patients with severely depressed left ventricular function Axel Unbehaun, MD, Miralem Pasic, MD, PhD, Semih Buz, MD, Stephan Dreysse, MD, Marian Kukucka, MD, Roland Hetzer, MD, PhD, Thorsten Drews, MD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 6, Pages 1356-1363 (June 2012) DOI: 10.1016/j.jtcvs.2011.07.008 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Computed tomographic scans of the chest before (left side) and 1 week after transapical aortic valve implantation (right side) in a 75-year-old male patient with advanced biventricular heart failure, porcelain aorta, severe tricuspid valve regurgitation, previous cardiodefibrillator implantation (ICD), and thrombus formation in the giant left atrium. The patient underwent replacement of the aortic valve and aortic root (28-mm homograft) owing to aortic valve stenosis, endocarditis, and annular abscess formation 13 years before. A biological mitral valve replacement (33-mm Hancock) was performed 2 years previously. Transapical aortic “valve-in-valve” implantation was performed under cardiopulmonary bypass (CPB) of short duration (13 minutes) after femorofemoral cannulation. Left ventricular ejection fraction (LVEF) increased from 20% preoperatively to 40% postoperatively. Functional New York Heart Association class improved from stage IV preoperatively to stage II 8 months after transapical aortic valve implantation. PE, Pleural effusion; RV, right ventricle; RA, right atrium with ICD lead; Ao, aorta with circumferential calcification of the implanted homograft; LV, enlarged left ventricle; LA, giant left atrium with adherent thrombus (Th); MV, 33-mm Hancock prosthesis; AV, 26-mm SAPIEN prosthesis. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1356-1363DOI: (10.1016/j.jtcvs.2011.07.008) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A,Valve deployment according to the “Berlin-addition technique”20 under short duration of cardiopulmonary bypass (black arrow, venous cannula). B, Angiographic results after transapical aortic valve implantation. The patient was preoperatively in cardiogenic shock, in acute renal failure with severe metabolic acidosis, and dependent on epinephrine and intra-aortic balloon counterpulsation. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1356-1363DOI: (10.1016/j.jtcvs.2011.07.008) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Left ventricular ejection fraction (LVEF) and end-diastolic diameter (LVEDD) in 21 patients with poor left ventricular performance (LVEF ≤ 25%) before and after transapical aortic valve implantation (TAVI). LVEF improved significantly up to 2 weeks after TAVI from 20.4% ± 5.3% to 38.4% ± 11.5%. LVEDD remained unchanged: 57.3 ± 8.6 mm preoperatively and 55.6 ± 8.6 mm postoperatively. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1356-1363DOI: (10.1016/j.jtcvs.2011.07.008) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The Kaplan-Meier survival function for 21 patients with a left ventricular ejection fraction (LVEF) between 10% and 25 % (solid line) and for 237 patients with an LVEF above 25% (dotted line). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1356-1363DOI: (10.1016/j.jtcvs.2011.07.008) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions