Self-expanding Devices for Transapical Aortic Valve Implantation: The Evolution Goes On

Objectives: Transcatheter aortic valve implantation (TAVI) is an established procedure in patients with severe aortic stenosis (AS). The transapical access remains important for patients not feasible for transfemoral TAVI. We present the results of 155 patients that underwent transapical TAVI and received a self-expanding transapical aortic valve prosthesis. Since the development of new prosthesis generations is expected to result in better device success and hemodynamics, we aim to examine the short- and long-term outcome, periprocedural complications and hemodynamics of two different generations of self-expanding transapical devices (Acurate TA vs. Acurate neo).

Methods: A total of 155 consecutive patients with severe aortic stenosis treated with transapical TAVI in our center were retrospectively analyzed. 85 patients received the early generation device and 70 the new generation device.

Results: Baseline characteristics showed no significant differences in both groups, except patients treated with early generation prosthesis had a significant higher STS score(5,3[3,7-7,6]vs. 4,1 [2,9-5,8]; p=0,002).There was a significant higher device success in the group of the new generation device (63 (74.1%) vs. 67 (97.1%); P< 0.001). This group had a significant higher post-procedural, echocardiographic Aortic Valve Area (1.35 [1.1-1.5]vs.1.6[1.4-1.9]; P=0.001) and lower a mean gradient (13.0 [9.3-17.0] vs.7.0 [5.0-11.0]; P< 0.001). 30-day and 1-year mortality rates did not differ significantly as well as major adverse cardiac events and major vascular complications.

Conclusions: Our single center experience shows that new generation self-expanding devices result in a higher device success and better hemodynamics compared to earlier generations of self-expanding TAVI prosthesis. Transapical TAVI remains an important treatment option for patients with severe AS not eligible for transfemoral access.