Circulation. 2006;113:842-850
Published online before print February 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.582882
Published online before print February 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.582882
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(Circulation. 2006;113:842-850.)
© 2006 American Heart Association, Inc.
Valvular Heart Disease |
Percutaneous Aortic Valve Implantation Retrograde From the Femoral Artery
From the Divisions of Cardiology and Cardiac Surgery, St. Paul’s Hospital, Vancouver, British Columbia, Canada.
Correspondence to John G. Webb, MD, Director, Interventional Cardiology, St. Paul’s Hospital, Room 5202A, 1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6. E-mail webb{at}providencehealth.bc.ca
Received August 11, 2005; revision received September 26, 2005; accepted October 21, 2005.
Background— Percutaneous aortic valve implantation by an antegrade transvenous approach has been described but is problematic. Retrograde prosthetic aortic valve implantation via the femoral artery has potential advantages. Percutaneous prosthetic aortic valve implantation via the femoral arterial approach is described and the initial experience reported.
Methods and Results— The valve prosthesis is constructed from a stainless steel stent with an attached trileaflet equine pericardial valve and a fabric cuff. After routine aortic balloon valvuloplasty, a 22F or 24F sheath is advanced from the femoral artery to the aorta. A steerable, deflectable catheter facilitates manipulation of the prosthesis around the aortic arch and through the stenotic valve. Rapid ventricular pacing is used to reduce cardiac output while the delivery balloon is inflated to deploy the prosthesis within the annulus. Percutaneous aortic prosthetic valve implantation was attempted in 18 patients (aged 81±6 years) in whom surgical risk was deemed excessive because of comorbidities. Iliac arterial injury, seen in the first 2 patients, did not recur after improvement in screening and access site management. Implantation was successful in 14 patients. After successful implantation, the aortic valve area increased from 0.6±0.2 to 1.6±0.4 cm2. There were no intraprocedural deaths. At follow-up of 75±55 days, 16 patients (89%) remained alive.
Conclusions— This initial experience suggests that percutaneous transarterial aortic valve implantation is feasible in selected high-risk patients with satisfactory short-term outcomes.
Key Words: aorta • stenosis • catheters • stents • valvuloplasty
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