Author's personal copy Transapical Aortic Valve Implantation— An Australian Experience Michael Seco, BMedSc a,b,c , Gonzalo Martinez, MD d , Paul G. Bannon, FRACS a,b,c , Bruce L. Cartwright, FANZCA e , Mark Adams, FRACP a,d , Martin Ng, FRACP a,d , Michael K. Wilson, FRACS b,c,f , Michael P. Vallely, FRACS a,b,c,f* a Sydney Medical School, The University of Sydney, Sydney, Australia b The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia c Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia d Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia e Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia f Australian School of Advanced Medicine, Macquarie University, Sydney, Australia Received 17 September 2013; received in revised form 21 October 2013; accepted 24 October 2013; online published-ahead-of-print 15 November 2013 © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved. *Corresponding author at: The Heart Care Centre, Suite 406, Macquarie University Hospital Specialists Centre, 3 Technology Place, Macquarie University NSW 2109, Australia. Tel.: +61294226090; fax: +61294226099., Email: michael.vallely@bigpond.com Background The aim of this study was to report our initial experience with the transapical approach to transcatheter aortic valve implantation (TAVI) at an Australian institution. Methods All patients with severe, symptomatic aortic stenosis were assessed by our multidisciplinary team. A total of 32 patients received a transapical TAVI using an Edwards SAPIEN prosthesis. Data were prospectively collected and analysed according to the Valve Academic Research Consortium version 2 guidelines. Results Intraoperative outcomes included: 100% device success with no conversion to surgical valve replacement, extracorporeal membrane oxygenation was used electively in 15.6% and emergently in 6.3%, and no valve migration or malpositioning requiring prosthesis retrieval and re-implantation. Outcomes at 30 days post-TAVI included: No mortality, 3.1% myocardial infarction, no disabling stroke, 3.1% non-disabling stroke, no transient ischaemic attacks, 6.3% life-threatening bleeding, 15.6% major bleeding, 3.1% major vascular complications, and 12.5% postoperative acute kidney injury requiring renal replacement therapy. Mild paravalvular regurgitation was present in 29%, and there was no moderate or severe regurgitation. Mean follow-up time was 28.8  12.9 months. Cumulative results included: 9.4% mortality, 6.3% stroke, 6.3% myocardial infarction, and no repeat procedures. At one year postoperation, echocardiography demonstrated that the mean pressure across the prosthesis was 10.1  1.7 mmHg, and the mean aortic valve area was 1.4  0.2 cm 2 . Conclusion Good short-term outcomes and low or zero mortality are achievable with transapical TAVI at an Australian institution. Keywords Transapical  Transcatheter aortic valve implantation  Heart valve prosthesis  Aortic valve stenosis Heart, Lung and Circulation (2014) 23, 462–468 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2013.10.095 ORIGINAL ARTICLE