Benefits and Complications of Direct Implantation of Self-Expandable Aortic Valve Prosthesis for Severe Aortic Stenosis

Oscar Méndiz, Hugo Fraguas, Gustavo Lev, León Valdivieso, Carlos Fava, Lorena Villagra, Gaspar Caponi, Antonio Semiglia, Eduardo Torres Torrico, Roberto Favaloro

Abstract


Objective

To describe the initial experience with aortic valve implantation via a direct approach using a self-expanding CoreValveTM aortic valve prosthesis in a tertiary care center from Argentina.

Material and methods

From May to December 2010, 21 consecutive patients with severe aortic stenosis (SAS) and high surgical risk undergoing percutaneous aortic valve replacement with CoreValveTM prosthesis were included. The inclusion criteria were the following: aortic valve area <1 cm2 (<0.6 cm2/m2); aortic annulus diameter of 20-27 mm; diameter of the ascending aorta at the level of the sinotubular junction £ 40 (small prosthesis) or £ 43 mm (large prosthesis), and femoral artery diameter >6 mm.

Results

Mean age was 79±8 years, mean aortic valve area was 0.7±0.2 cm2 and mean logistic EuroSCORE was 26±15% (50% with logistic EuroSCORE ³ 20%). After valve implantation, peak transaortic pressure gradient measured by echocardiography decreased from 80±22 to 14±5 mm Hg. Two patients developed severe aortic regurgitation which improved with post-dilation. The success rate of the procedure was of 95% as a patient died immediately after valve implant. A definite pacemaker was implanted to six patients due to atrioventricular block. Cumulative survival was 75% after a mean follow-up of 5±2.8 months.

Conclusion

Our initial experience suggests that direct implantation of CoreValveTM prosthesis is a safe and feasible therapeutic option for patients with SAS and high surgical risk.


References


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar