Abstract 2472: High-risk Aortic Valve Surgery: Exploring the Potential Role of the Percutaneous Procedures
Objective. To estimate
the potential for application of percutaneous heart valve (PHV) implantation in the aortic position, and
the results of conventional aortic valve replacement in patients with high-risk preoperative profile.
Methods. In January 2003 we started a prospective registry preliminary to the eventual introduction of PHV at our Institution. All patients potential candidates for PHV on the basis of the current indications were included. Main inclusion criteria were aortic stenosis with surgical indication and EuroSCORE >9.
Results. Between 2003 and 2006 a total of 1,588 patients were screened; 152 (9.6%) entered the registry. Mean EuroSCORE was 12.1±3.0. Of these, 91 were excluded due to conditions compromising the safety/feasibility of PHV (coronary artery disease not treatable percutaneously, 69 cases; bilateral severe femoral arterial disease, 32 cases; unclampable ascending aorta, 39 cases), and only 61 patients were finally eligible for PHV (3.8% of all aortic valve operations). Among these, operative mortality-rate was 9.8%, major adverse cerebrovascular events-rate was 6.5%. End-of-follow-up mortality-rate was 31.1% with 83% of survivors being in NYHA class I–II. Results were not significantly different among patients included in the registry and considered not suitable for PHV. The annual percentage of patients amenable of PHV dropped from 6% in 2003 to 2.2% in 2006 (p=.0098).
Conclusions. The percentage of potential candidates for PHV is extremely limited (3.8% of all aortic valve patients referred). The annual percentage of candidates dropped steadily. The current results of conventional aortic valve replacement are excellent even in high-risk cases. These findings raise perplexity over the potential clinical impact of PHV.