Abstract 2533: Early Experience with the CoreValve Percutaneous Aortic Valve in Patients with an Unacceptably High Risk for Surgical Aortic Valve Replacement
Objectives: Surgical aortic valve replacement is the only recommended treatment for prognostically important aortic valve stenosis. In certain cases, however, surgery is not appropriate because of a high probability of an adverse perioperative outcome. Non-surgical candidates have no other alternative to palliative medical management. Percutaneous aortic valve replacement (PAVR) is now an emerging, novel option for some non-surgical candidates. We report the first North American experience of the Revalving™ system from CoreValve (Paris, France).
Methods: All patients included in this early experience had been assessed by at least two cardiac surgeons and deemed to have an unacceptable operative risk due to comorbidity. To date, 4 patients (3 women and 1 man) have undergone PAVR. After careful anesthesia, one patient underwent percutaneous revascularization for a critical left anterior descending artery stenosis. Another patient underwent left iliac artery angioplasty to allow passage of the CoreValve delivery catheter. All patients were placed on femoro-femoral cardiopulmonary bypass (<30 min). Aortic balloon valvuloplasty was then performed followed by retrograde aortic valve replacement with the Revalving™ system, which includes a 21-French catheter and a porcine pericardial prosthesis mounted within a self-expandable Nitinol mesh.
Results: Peri-procedural transesophageal echocardiography revealed immediate improvements in all cases, with an aortic prosthetic valve area consistently >1.2cm2 associated with minimal paravalvular leaks. Notably, these valve leaks had disappeared almost completely by the end of the procedure in all of cases. The patients were easily weaned from ventilator and returned home soon after the intervention. Early follow-up (up to 4 months) confirms hemodynamic and clinical improvements in all patients.
Conclusion: PAVR with the self-expandable CoreValve prosthesis is feasible and safe. A multidisciplinary approach in this high-risk population is necessary to ensure optimal procedural outcomes.