Thorac cardiovasc Surg 2014; 62(06): 498-502
DOI: 10.1055/s-0034-1381743
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Successful Use of a Left Ventricular Apical Access and Closure Device for Second-Generation Transapical Aortic Valve Implantation

Lenard Conradi
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Moritz Seiffert
2  Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Kazuo Shimamura
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Johannes Schirmer
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Stefan Blankenberg
2  Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Hermann Reichenspurner
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
Patrick Diemert
2  Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
Hendrik Treede
1  Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

06 February 2014

04 April 2014

Publication Date:
09 June 2014 (eFirst)

Abstract

Background Transcatheter aortic valve implantation (TAVI) has become routine for the treatment of high-risk patients with aortic stenosis. We assessed safety and feasibility of a left ventricular apical access and closure device combined with second-generation transapical (TA) TAVI transcatheter heart valves (THV).

Methods and Results Three elderly, comorbid patients (logEuroSCORE I 13.0–31.1%) received transapical aortic valve implantation (TA-AVI) via the Apica ASC device (Apica Cardiovascular Ltd., Galway, Ireland) using second-generation THV (Medtronic Engager [Medtronic 3F Therapeutics, Santa Ana, California, United States], JenaValve [JenaValve Technology GmbH, Munich, Germany], Symetis Acurate [Symetis S.A., Ecublens, Switzerland]). Access was gained using a non–rib-spreading technique and a novel access and closure device. THV deployment was successful with excellent hemodynamic outcome (no PVL, n = 2; trace PVL, n = 1; mean transvalvular gradients, 5–19 mm Hg) and complete apical hemostasis. No periprocedural major adverse events occurred and Valve Academic Research Consortium-2–defined composite end point of device success was met in all cases.

Conclusion Safety and feasibility of TA-AVI using the ASC device with second-generation THV was demonstrated. Combining latest available technology is a major step toward improved functional outcome and decreased surgical trauma in TA-AVI. Potentially, technical enhancements may eventually pave the way toward a fully percutaneous TA-AVI procedure.