Transaortic Aortic Valve Replacement Using the Edwards Sapien-XT Valve and the Medtronic CoreValve: Initial Experience

Introduction: Transcatheter aortic valve replacement (TAVR) is now an established treatment for certain patients with severe aortic valve stenosis (AS). However, as the number of patients screened for TAVR increases, many are found to have absolutely no option for peripheral artery access. Transaortic valve replacement (TAoVR) has been proposed as a new alternative route in patients deemed unsuitable for conventional approaches. We present our first series of TAoVR cases using the Edwards Sapien-XT and the Medtronic CoreValve prostheses. Methods: Twenty-five (25) symptomatic patients (mean age 78 +/- 8 years, mean logistic EuroSCORE I 25 +/- 11%) with severe AS underwent TAoVR using the Sapien-XT valve (10 patients) or the CoreValve (15 patients). Results: The mean fluoroscopy time was 15.6 +/- 4.2 minutes, the mean time in the intensive care unit was 1.9 +/- 1.0 days, and the mean hospital stay was 6.4 +/- 1.6 days. The mean effective aortic valve area increased (from 0.68 +/- 0.15 cm(2) to 1.82 +/- 0.34 cm(2), p < 0.001) and the mean transvalvular pressure gradient declined (from 48 +/- 15 mmHg to 9 +/- 5 mmHg, p < 0.05) post implantation. The procedural mortality was 0% and the in-hospital mortality was 4% (one death at day 3 due to cardiogenic shock). The mean NY-HA functional class improved from 3.2 +/- 0.4 to 1.5 +/- 0.9 at 30 days. Conclusions: Our initial experience with the TAoVR approach using both the Edwards Sapien-XT and the Medtronic CoreValve prosthesis demonstrated that it could be performed safely, resulting in substantial acute echocardiographic and early clinical improvement.