ABSTRACT

Transcatheter-based aortic valve procedures have undergone a tremendous evolution and have led to great changes in the treatment of aortic valvular disease. In patients with severe peripheral arterial disease, transapical aortic valve implantation is an important alternative to surgical aortic valve replacement. Hereby we present our first case of transapical aortic valve implantation in an 80 year-old patient.

An 80-year old female patient applied with dyspnea on minimal exertion (NYHA Class III). Transthoracic echocardiography showed severe aortic stenosis (gradients of 76/45 mmHg, aortic valve area of 0.72 cm2). Patient had a history of coronary artery bypass grafting and chronic obstructive pulmonary disease. Calculated Euroscore was 16.4% and due to the high surgical risk and presence of diffuse vascular disease, transapical aortic valve implantation was decided to be the optimal choice for the patient. The procedure was performed in the catheter laboratory under general anesthesia via a 5-6 cm anterolateral thoracotomy and via transapical approach. Fluoroscopy was used to guide the catheter across the native valve and direct deployment of the stent at the level of the annulus. A 26 mm Edwards Novoflex (Edwards Lifesciences, Irvine, CA) aortic valve was used. Postoperative echocardiography showed no transvalvular gradient and aortic regurgitation. Aorta flow was 1.1 m/s.

Transcatheter-based aortic valve procedures avoid the risks associated with open heart surgery and therefore are generally indicated in patients with high surgical risk. Although TAVI is the first alternative to SAVR in high risk patients, TA-TAVI is a safe and effective option in those unsuitable for TAVI.