Cited 25 times since 2012 (1.9 per year) source: EuropePMC European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Volume 43, Issue 3, 30 5 2012, Pages 505-11; discussion 511-2 Transapical aortic valve implantation: mid-term outcome from the SOURCE registry. Wendler O, Walther T, Schroefel H, Lange R, Treede H, Fusari M, Rubino P, Thomas M, SOURCE investigators

Objectives

Transapical (TA) aortic valve implantation using the Edwards SAPIEN bioprosthesis was commercially introduced in Europe in January 2008. Limited data on the mid-term results are available.

Methods

Using data from the SOURCE-Registry (largest consecutive cohort treated using Edwards SAPIEN bioprosthesis in Europe), we report on the mid-term results (≥30 days-2 years) of TA patients.

Results

Between November 2007 and December 2009, a total of 1387 patients from 38 European centres underwent TA aortic valve implantation. The mean follow-up is 14.9 months, with 1004 patients who completed 1 year and 464 patients who completed the 2-year follow-up. The mean age of patients was 80.6 ± 7.1 years with a logistic-EuroSCORE of 27.6%. The main co-morbidities were coronary artery disease (55.8%), previous bypass grafting (25.5%), porcelain aorta (10.2%), previous stroke (6.5%) and peripheral vascular disease (26.4%). A total of 840 patients (60.6%) received a 26 mm and 535 (38.6%) a 23 mm Edwards SAPIEN bioprosthesis. Survivals at 30 days, 1 year and 2 years were 88.7, 73.8 and 65.1%, respectively. Causes of the 276 deaths observed between >30 days and 2-year follow-up were cardiac in 86 patients (31.2%), non-cardiac in 142 (51.4%) and unknown in 48 (17.4%). Cardiac causes of death included heart failure (33.7%), sudden cardiac death (33.7%), myocardial infarct (8.1%), endocarditis (5.8%) and others (18.6%). Non-cardiac deaths were related to pulmonary disease (21.1%), cancer (12.7%), renal failure (11.3%), stroke (10.6%), gastrointestinal disease (7.7%) and others (36.6%). Using univariable and multivariable analyses, logistic EuroSCORE, renal insufficiency and liver diseases were identified as independent predictors of 2-year mortality.

Conclusions

These results demonstrate that in elderly patients with severe co-morbidities, TA aortic valve implantation results in excellent mid-term results. Causes of death during the mid-term follow-up are mainly non-cardiac and related to co-morbidities.

Eur J Cardiothorac Surg. 2012 5;43(3):505-11; discussion 511-2