Abstract

BATTELLINI, Roberto et al. Transapical Aortic Valve Implantation. Rev. argent. cardiol. [online]. 2009, vol.77, n.2, pp.96-100. ISSN 1850-3748.

Almost 30% of aortic valve replacements are due to aortic stenosis; therefore, certain groups of patients present high operative risk. This article describes transapical aortic valve implantation, a minimally invasive off-pump procedure. This technique represents a new alternative for patients with advanced age and increased operative risk, severe calcifications of the aorta, or previous coronary revascularization. Delineation of the aortic root geometry is essential. Transesophageal echocardiography is the most reliable tool to measure the diameter of the aortic root. Computerized tomography is another method of determining the width of the aortic annulus and it has the added ability of measuring the distance from the aortic annulus to the coronary ostia. Cardiopulmonary bypass should be available as a stand-by during all the procedure, which consists of an anterolateral mini-thoracotomy for direct antegrade surgical access through the apex of the left ventricle; then a catheter is inserted and placed in the aortic position under fluoroscopic guidance. Balloon valvuloplasty is performed thereafter, followed by transapical sheath insertion and prosthetic valve positioning. Exact valve positioning is the most critical step. The use of DYNA CT imaging software has improved the perspectives for the definite development of this technique. From February 2006 to December 2008, 192 aortic valves have been implanted transapically; mean age of patients was 82.5±5.7 years. Mortality 30 days after the procedure was 8.9% and 12.8% at long-term follow-up (256±213 days). Implantations are optimally performed in a hybrid operating room by an experienced team of cardiac surgeons, cardiologists, and anesthetists.

Keywords : Aortic Valve; Transapical Aortic Valve Implantation; Minimally Aortic Valve Surgery.

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