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

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)