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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S. H. Goldbarg, S. Elmariah, M. A. Miller, and V. Fuster Insights Into Degenerative Aortic Valve Disease J. Am. Coll. Cardiol., September 25, 2007; 50(13): 1205 - 1213. [Abstract] [Full Text] [PDF]
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J. G. Webb, S. Pasupati, K. Humphries, C. Thompson, L. Altwegg, R. Moss, A. Sinhal, R. G. Carere, B. Munt, D. Ricci, et al. Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis Circulation, August 14, 2007; 116(7): 755 - 763. [Abstract] [Full Text] [PDF]
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E. M. Flecher, J. W. Curry, T. M. Joudinaud, C. L. Kegel, P. A. Weber, and C. M.G. Duran Coronary flow obstruction in percutaneous aortic valve replacement. An in vitro study Eur. J. Cardiothorac. Surg., August 1, 2007; 32(2): 291 - 294. [Abstract] [Full Text] [PDF]
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S. R. Dixon, C. L. Grines, and W. W. O'Neill The Year in Interventional Cardiology J. Am. Coll. Cardiol., July 17, 2007; 50(3): 270 - 285. [Full Text] [PDF]
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E. Grube, G. Schuler, L. Buellesfeld, U. Gerckens, A. Linke, P. Wenaweser, B. Sauren, F.-W. Mohr, T. Walther, B. Zickmann, et al. Percutaneous Aortic Valve Replacement for Severe Aortic Stenosis in High-Risk Patients Using the Second- and Current Third-Generation Self-Expanding CoreValve Prosthesis: Device Success and 30-Day Clinical Outcome J. Am. Coll. Cardiol., July 3, 2007; 50(1): 69 - 76. [Abstract] [Full Text] [PDF]
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J. Bergler-Klein, G. Mundigler, P. Pibarot, I. G. Burwash, J. G. Dumesnil, C. Blais, C. Fuchs, D. Mohty, R. S. Beanlands, Z. Hachicha, et al. B-Type Natriuretic Peptide in Low-Flow, Low-Gradient Aortic Stenosis: Relationship to Hemodynamics and Clinical Outcome: Results From the Multicenter Truly or Pseudo-Severe Aortic Stenosis (TOPAS) Study Circulation, June 5, 2007; 115(22): 2848 - 2855. [Abstract] [Full Text] [PDF]
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L. Coats and P. Bonhoeffer NEW PERCUTANEOUS TREATMENTS FOR VALVE DISEASE Heart, May 1, 2007; 93(5): 639 - 644. [Full Text] [PDF]
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J. Ye, A. Cheung, S. V. Lichtenstein, S. Pasupati, R. G. Carere, C. R. Thompson, A. Sinhal, and J. G. Webb Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 16 - 21. [Abstract] [Full Text] [PDF]
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Y. Lamarche, R. Cartier, A. Y. Denault, A. Basmadjian, C. Berry, J.-C. Laborde, and R. Bonan Implantation of the CoreValve Percutaneous Aortic Valve Ann. Thorac. Surg., January 1, 2007; 83(1): 284 - 287. [Abstract] [Full Text] [PDF]
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E. Grube, J. C. Laborde, U. Gerckens, T. Felderhoff, B. Sauren, L. Buellesfeld, R. Mueller, M. Menichelli, T. Schmidt, B. Zickmann, et al. Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease: The Siegburg First-in-Man Study Circulation, October 10, 2006; 114(15): 1616 - 1624. [Abstract] [Full Text] [PDF]
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B Munt and J Webb Percutaneous valve repair and replacement techniques Heart, October 1, 2006; 92(10): 1369 - 1372. [Abstract] [Full Text] [PDF]
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J. D. Carroll The Evolving Treatment of Aortic Stenosis: Do New Procedures Provide New Treatment Options for the Highest-Risk Patients? Circulation, August 8, 2006; 114(6): 533 - 535. [Full Text] [PDF]
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S. V. Lichtenstein, A. Cheung, J. Ye, C. R. Thompson, R. G. Carere, S. Pasupati, and J. G. Webb Transapical Transcatheter Aortic Valve Implantation in Humans: Initial Clinical Experience Circulation, August 8, 2006; 114(6): 591 - 596. [Abstract] [Full Text] [PDF]
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S. V. Lichtenstein Closed heart surgery: Back to the future J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 941 - 943. [Full Text] [PDF]
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J. Ye, A. Cheung, S. V. Lichtenstein, R. G. Carere, C. R. Thompson, S. Pasupati, and J. G. Webb Transapical aortic valve implantation in humans J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1194 - 1196. [Full Text] [PDF]
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T. Feldman Percutaneous Valve Repair and Replacement: Challenges Encountered, Challenges Met, Challenges Ahead Circulation, February 14, 2006; 113(6): 771 - 773. [Full Text] [PDF]
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R. J. Shemin Percutaneous Valve Intervention: A Surgeon's Perspective Circulation, February 14, 2006; 113(6): 774 - 775. [Full Text] [PDF]
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