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

Abstract

Objective To describe the initial experience with aortic valve implantation via a direct approach using a self-expanding CoreValve TM 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 CoreValve TM prosthesis were included. The inclusion criteria were the following: aortic valve area 6 mm. Results Mean age was 79±8 years, mean aortic valve area was 0.7±0.2 cm 2 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 CoreValve TM prosthesis is a safe and feasible therapeutic option for patients with SAS and high surgical risk.