on July 23, 2007
Circulation. 2007
Published online before print July 23, 2007, doi: 10.1161/CIRCULATIONAHA.107.698258
Published online before print July 23, 2007, doi: 10.1161/CIRCULATIONAHA.107.698258
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Submitted on February 22, 2007
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. * To whom correspondence should be addressed. E-mail: webb{at}providencehealth.bc.ca.
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.
Accepted on June 1, 2007
Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic Stenosis
John G. Webb MD*,
Key words: stenosis • stents • valves • valvuloplasty
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Circulation 2007 116: 685.
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N. Piazza, Y. Onuma, E. Jesserun, P. P. Kint, A.-M. Maugenest, R. H. Anderson, P. P. T. de Jaegere, and P. W. Serruys Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 310 - 316. [Abstract] [Full Text] [PDF]
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B. Iung Management of the elderly patient with aortic stenosis Heart, April 1, 2008; 94(4): 519 - 524. [Full Text] [PDF]
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J. G. Webb Percutaneous Aortic Valve Replacement Will Become a Common Treatment for Aortic Valve Disease J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 122 - 126. [Abstract] [Full Text] [PDF]
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B. A. Carabello Aortic Stenosis: A Fatal Disease With But a Single Cure J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 127 - 128. [Full Text] [PDF]
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P. Schoenhagen Back to the future: coronary CT angiography using prospective ECG triggering Eur. Heart J., January 2, 2008; 29(2): 153 - 154. [Full Text] [PDF]
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W. J. Stewart Imaging the future of transcatheter aortic valve replacement. J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 25 - 28. [Full Text] [PDF]
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