Transcatheter Aortic Valve Implantation in patients with Concomitant Aortic Diseases

Objectives: Patients with concomitant aortic diseases (AD) who need Transcatheter Aortic Valve Implantation (TAVI) treatment are frequent and are likely to be classified as high interventional risk or patients who cannot undergo transfemoral approach. Since “transfemoral first” strategy has been established there is an evidence gap with regard to the outcomes of such a patients. We aimed to evaluate long term outcomes after transapical TAVI in patients with AD.

Methods: Fifty-one consecutive intermediate risk, elderly patients (78 ± 8.6 years) with symptomatic severe aortic stenosis and AD (porcelain aorta 35.2%, ascending aneurysm 9.8%, descending aneurysm 25.4%, type-B-dissection 3.9%, aortic thrombus 7.8%, Leriche syndrome 3.9%, aortic kinking 9.8%, aortic ulcer 1.9%, previous aortic operation 19.6%, aortic elongation/tortuosity 3.9%) underwent transapical TAVI treatment between January 2011 and August 2019 at our institution. We used the second- and the last-generation self- and balloon-expanding valves. The follow-up time was 92.2 patient-years.

Results: The STS-score was 6.8 ± 3.8. Thirty-day mortality, all-stroke, and myocardial infarction were 5.8, 5.8, and 0%, respectively. One-year, 3-year, and 5-year all-cause mortality rates were 35.2, 54.9, and 60.7%, respectively. The cumulative late all-stroke and myocardial infarction were 6.3 and 6.3%, respectively. Postoperative PVL ≥ 2 was 1.9%. The rate of PPI was 8.3%. We registered no early or late aortic syndrome. One patient received aortic stent.

Conclusion: The transapical TAVI seems to be a safe method and shows very promising early and long-term outcomes, without early or late aortic syndrome in patients with AD, where the transfemoral TAVI as first transcatheter alternative might be contraindicated or even not feasible.