Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk

Fernando Cura, Alfonsina Candiello, Hugo Londero, Francisco Paoletti, Marcelo Bettinotti, Carlos Sztejfman, Anibal Damonte, Daniel Navia, Ricardo Ronderos, Jorge A. Belardi

Abstract


Background

Aortic valve replacement is the treatment of choice in pa­tients with aortic stenosis. However, a significant number of patients are not candidates for surgery due to high surgical risk and to the presence of comorbidities. Percutaneous aortic valve replacement represents an alternative option to con­ventional aortic valve surgery for selected high risk patients.

Objective

To inform about the initial experience with percutaneous aortic valve replacement with a self-expanding CoreValve aortic valve prosthesis (Medtronic, Minneapolis, MN, USA).

Material and Methods

We conducted a multicenter registry including 21 patients with severe symptomatic aortic stenosis (aortic valve area ≤1cm2) and high surgical risk undergoing percutaneous aortic valve replacement in four high complexity cardiovascular centers. A multidisciplinary strategy was used involving sev­eral specialists: anesthesiologist, surgeon, diagnostic images specialists and interventional cardiologists.

Results

Mean age was 80.8±7.1 years (range: 63-90); 57% were men. Mean aortic valve area was 0.59±0.25 cm2 and mean EuroSCORE was 18.1%±4%. The percentages of patients in functional class III and IV were 73% and 27%, respectively. The procedure was successful in 95.2% (20/21) of patients, with a pronounced reduction in peak transvalvular aortic gradient (from 82±14 mm Hg to 12±3 mm Hg; p <0,001); 14% of patients developed moderate to severe aortic regurgi­tation after the procedure. 85.5% of patients evolved to FC I. Definite pacemaker implantation was required in 38% (8/21). Procedure-related mortality was 4.7% and mortality after 30 days was 9.5%. (continue in pdf)


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The documents published in this journal are under the licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.

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