Published Online
on June 1, 2009

A more recent version of this article appeared on June 16, 2009

This Article Full Text (PDF) All Versions of this Article: 119/23/3009    most recent CIRCULATIONAHA.108.837807v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Webb, J. G. Articles by Humphries, K. Search for Related Content PubMed PubMed Citation Articles by Webb, J. G. Articles by Humphries, K. Related Collections Other heart failure Catheter-based coronary and valvular interventions: other CV surgery: valvular disease Related Article

Submitted on November 24, 2008
Accepted on April 6, 2009

Transcatheter Aortic Valve Implantation. Impact on Clinical and Valve-Related Outcomes

John G. Webb MD^*, Lukas Altwegg MD, Robert H. Boone MD, Anson Cheung MD, Jian Ye MD, Samuel Lichtenstein MD, PhD, May Lee MSc, Jean Bernard Masson MD, Christopher Thompson MD, Robert Moss MD, Ron Carere MD, Brad Munt MD, Fabian Nietlispach MD, and Karin Humphries 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.

^* To whom correspondence should be addressed. E-mail: webb{at}providencehealth.bc.ca.

Background—Transcatheter aortic valve implantation is an alternative to open heart surgery in patients with aortic stenosis. However, long-term data on a programmatic approach to aortic valve implantation remain sparse.

Methods and Results—Transcatheter aortic valve implantation was performed in 168 patients (median age, 84 years) in the setting of severe aortic stenosis and high surgical risk. Access was transarterial (n=113) or, in the presence of small iliofemoral artery diameter, transapical (n=55). The overall success rate was 94.1% in this early experience. Intraprocedural mortality was 1.2%. Operative (30-day) mortality was 11.3%, lower in the transarterial group than the transapical group (8.0% versus 18.2%; P=0.07). Overall mortality fell from 14.3% in the initial half to 8.3% in the second half of the experience, from 12.3% to 3.6% (P=0.16) in transarterial patients and from 25% to 11.1% (P=0.30) in transapical patients. Functional class improved over the 1-year postprocedure period (P<0.001). Survival at 1 year was 74%. The bulk of late readmission and mortality was not procedure or valve related but rather was due to comorbidities. Paravalvular regurgitation was common but generally mild and remained stable at late follow-up. At a maximum of >3 years and a median of 221 days, structural valve failure was not observed.

Conclusions—Transcatheter aortic valve implantation can result in early and sustained functional improvement in high-risk aortic stenosis patients. Late outcome is determined primarily by comorbidities unrelated to aortic valve disease.

Key words: aortic valve • aortic valve stenosis • catheters • prosthesis • valves • valvuloplasty

Related Article:

Circulation: Clinical Summaries
Circulation 2009 119: 2963-2964. [Extract] [Full Text]

This article has been cited by other articles:

				M. Thielmann, D. Wendt, H. Eggebrecht, P. Kahlert, P. Massoudy, M. Kamler, R. Erbel, H. Jakob, and S. Sack Transcatheter aortic valve implantation in patients with very high risk for conventional aortic valve replacement. Ann. Thorac. Surg., November 1, 2009; 88(5): 1468 - 1474. [Abstract] [Full Text] [PDF]

				J.-B. Masson, J. Kovac, G. Schuler, J. Ye, A. Cheung, S. Kapadia, M. E. Tuzcu, S. Kodali, M. B. Leon, and J. G. Webb Transcatheter Aortic Valve Implantation: Review of the Nature, Management, and Avoidance of Procedural Complications J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 811 - 820. [Abstract] [Full Text] [PDF]