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(Circulation. 2007;116:755-763.)
© 2007 American Heart Association, Inc.

Valvular Heart Disease

Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis

John G. Webb, MD; Sanjeevan Pasupati, MBChB; Karin Humphries, PhD; Christopher Thompson, MD; Lukas Altwegg, MD; Robert Moss, MD; Ajay Sinhal, MD; Ronald G. Carere, MD; Brad Munt, MD; Donald Ricci, MD; Jian Ye, MD; Anson Cheung, MD; Sam V. Lichtenstein, MD, PhD

From the Divisions of Cardiology and Cardiac Surgery, St Paul’s Hospital and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Correspondence to John Webb, MD, Director, Cardiac Catheterization, St. Paul’s Hospital, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6. E-mail webb{at}providencehealth.bc.ca

Received February 22, 2007; accepted June 1, 2007.

Background— Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass.

Methods and Results— Transcatheter implantation of a balloon-expandable stent valve using a femoral arterial approach was attempted in 50 symptomatic patients with severe aortic stenosis in whom there was a consensus that the risks of conventional open heart surgery were very high. Valve implantation was successful in 86% of patients. Intraprocedural mortality was 2%. Discharge home occurred at a median of 5 days (interquartile range, 4 to 13). Mortality at 30 days was 12% in patients in whom the logistic European System for Cardiac Operative Risk Evaluation risk score was 28%. With experience, procedural success increased from 76% in the first 25 patients to 96% in the second 25 (P=0.10), and 30-day mortality fell from 16% to 8% (P=0.67). Successful valve replacement was associated with an increase in echocardiographic valve area from 0.6±0.2 to 1.7±0.4 cm². Mild paravalvular regurgitation was common but was well tolerated. After valve insertion, there was a significant improvement in left ventricular ejection fraction (P<0.0001), mitral regurgitation (P=0.01), and functional class (P<0.0001). Improvement was maintained at 1 year. Structural valve deterioration was not observed with a median follow-up of 359 days.

Conclusion— Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high-risk patients with severe symptomatic aortic stenosis.

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