Percutaneous implantation of the CoreValve aortic valve prosthesis in patients at high risk or rejected for surgical valve replacement: Clinical evaluation and feasibility of the procedure in the first 30 patients in the AMC-UvA |
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Authors: | J Baan ZY Yong KT Koch JPS Henriques BJ Bouma SG de Hert J van der Meulen JGP Tijssen JJ Piek BAJM de Mol |
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Institution: | 1.Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;2.Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;3.Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands* These authors contributed equally;4.Department of Clinical Epidemiology and Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands |
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Abstract: | Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the CoreValve ReValving System was performed under general anaesthesia in 30 high-risk (surgical) patients with a symptomatic severe aortic valve stenosis.Results. The patients had a mean age of 80.5±7.7 years, a mean aortic valve area of 0.71±0.19 cm2, a peak transvalvular aortic gradient of 79±25 mmHg, as measured with echo Doppler, a logistic EuroSCORE of 15±10% and a Society of Thoracic Surgeons (STS) score of 5.2±2.9%. Device success was achieved in all patients and acute procedural success in 27 patients (90%). In the surviving patients, there was in a reduction of the peak aortic pressure gradient from 76±24 mmHg to 22±7 mmHg (n=24, p<0.00001) 30 days after successful device implantation. At 30 days, major adverse cardiovascular and cerebral events had occurred in seven patients (23%). This included mortality in six patients (20%), of which one death was cardiovascular. The other five non-cardiovascular deaths involved two patients who died of an exacerbation of severe pre-existent pulmonary disease and three of infectious complications.Conclusions. Percutaneous aortic valve implantation was successfully performed in our centre in highrisk patients, with a 30-day mortality of 20%. When successful, marked haemodynamic improvement and relief of symptoms was achieved. (Neth Heart J 2010;18:18-24.) |
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Keywords: | aortic valve stenosis valvuloplasty transcatheter valve therapy |
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