Analysis of survival in 300 high-risk patients up to 2.5 years after transapical aortic valve implantation.

BACKGROUND: Midterm results after transapical aortic valve implantation are still unknown in a large group of patients. We report our institutional experience in 300 high-risk patients.

METHODS: Since April 2008, transapical aortic valve implantation was performed in 300 patients (mean age, 80 ± 8 years). The mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 39% ± 19% and the mean Society of Thoracic Surgeons (STS) score was 19% ± 16%. Eighteen patients were in cardiogenic shock preoperatively. Follow-up was up to 31 months with a total of 3,500 months of follow-up.

RESULTS: Technical success of the procedure was 99.7% (299 of 300 patients). The 30-day mortality rate in all patients without cardiogenic shock was 3.9%. The overall 30-day mortality for the whole group of 300 patients was 4.7%. The mortality of the last 100 patients dropped to 2.0%. The cumulative survival was 83% at 1 year, 76% at 1.5 years, and 65% at 2 years and beyond. In patients with lower risk scores, cumulative survival reached 78% at 2 years and beyond.

CONCLUSIONS: The outcome of transapical aortic valve implantation in very high-risk patients was very favorable not only early after the procedure but also later on. Preoperative risk scores were not indicators for early mortality but were for later mortality. Survival was mainly influenced by noncardiac (renal, pulmonary, and vascular) comorbidities as well as by signs of advanced cardiac failure.