A Look at Transapical Aortic Valve Implantation

Transapical aortic valve implantation (AVI) is a minimally invasive technique that replaces the aortic valve through the placement of a small incision under the left breast—directly below the heart—without using cardiopulmonary bypass. It’s designed for patients who do not have appropriate sized femoral vessels in the groin for the treatment of aortic stenosis.

Transapical AVI is actually a type of transcatheter valve implantation. There are two ways to go about this sort of implantation: through transapical or transfemoral routes (a transfemoral procedure involves an incision in the groin area).

Transapical AVI is often referred to as an “off-pump” procedure, as routine surgical aortic valve replacement (AVR) requires that the breastbone be opened, and patients must be placed on a heart lung machine. Conversely, transapical AVI doesn’t involve opening the breastbone, nor does the procedure require utilization of the heart lung machine; hence the term “off-pump.”

So, why would a surgeon opt for transapical AVI, as opposed to transfemoral AVI? If a patient has too much calcium in their arteries or groin, this prevents us from being able to insert catheters in these areas, creating a case for transapical AVI.

Some of the typical candidates for this procedure include patients with severe aortic stenosis, or those who have blockage of the aortic valve. However, some patients do not qualify for this procedure, particularly for the purposes of the trial that Dr. Block mentioned in his last post. These include patients who are on dialysis, or who have had previous valve surgery. That said—we do anticipate that these parameters may change, potentially in late 2011.

Emory is truly a “one-stop-shop” in that we offer a multitude of services for the treatment of aortic stenosis: minimally invasive AVR, transcatheter AVI (transfemoral or transapical), off-pump left ventricle to descending aorta bypass, or balloon aortic valvuloplasty.  We are truly fortunate to be able to provide all of these services for our patients.

If you have any questions about transapical AVI or any of the numerous procedures we offer at Emory Heart & Vascular, please feel free to let me know in the comments section, or call me at 404-686-2513.

About Vinod H. Thourani, MD:

Dr. Thourani specializes in minimally invasive valve surgery (including mitral valve repair and replacement and aortic valve surgery) and transcatheter valve surgery (transfemoral and transapical aortic valve implantation).  He also performs other facets of adult cardiac surgery including on and off-pump coronary artery revascularization and atrial fibrillation surgery. He completed his general surgery residency, cardiothoracic residency, and cardiothoracic surgical research and clinical fellowships at Emory University.  Dr. Thourani joined Emory as a faculty member in 2005.

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