Technical Considerations on the Transapical Jenavalve Implantation

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Abstract

Background: Senile aortic stenosis is currently the most frequent disease in cardiac surgery, though surgical treatment is limited in high risk patients. In these cases, transcatheter aortic valve implantation (TAVI) is the alternative technique.

Objective: The aim of this study was to evaluate and describe in detail the technique with transapical approach as primary or secondary indication when other access sites are not feasible.

Methods: Among a total of 51 patients treated with TAVI, the study analyzed 28 patients undergoing transapical approach (TA-TAVI) with Jenavalve™ porcine biological valve from March 2014 to March 2016.

Results: The transapical procedure was possible in all the selected patients. Immediate postoperative mortality was 10.71% (3/28) and no causes were attributable to the transapical approach. Morbidity was 28.57% (8/28).

Conclusions: In some cases, femoral or axillary access is not feasible, mainly due to inadequate anatomy or existing disease. The transapical approach appears then as strict indication. However, some groups propose its use as a first-choice strategy to facilitate implantation and lower the risk of embolic events. The transapical approach with rigorous technique allows implantation of this type of aortic valve prosthesis. Minimal access is well tolerated by this critical group of patients. The observed mortality was not associated with the approach.