Abstract 3389: Percutaneous Aortic Valve Replacement with a self expandable bioprosthesis: Early and Intermediate Echocardiographic Follow-up
Background: Aortic valve replacement in elderly patients with severe aortic valve stenosis (AS) is associated with high morbidity/mortality. The echocardiographic findings after percutaneous aortic valve replacement (PAVR) are unknown.
Methods: Symptomatic AS patients (n=38, age: 80±5 years, 62% female) ineligible for operative replacement underwent PAVR with the 21French CoreValve ReValvingTM System (CoreValve Inc, Irvine, CA); mean gradient [MG]: 38±12 mmHg, mean aortic valve area (AVA) 0.66±0.20cm2. Serial echocardiograms were performed at baseline (TTE=36, TEE=2), peri-procedure (TEE=17), and at 10-days (TTE=35), 1- (TTE=27, TEE=1), 3- (TTE=29), 6- (TTE=20), and 12-months (TTE=5) after PAVR to evaluate gradients and aortic paravalvular regurgitation (PVR). Mixed linear model with repeated measures assessed changes over time.
Results: Immediately post-implantation, TEE showed a normal functioning, well-seated valve. At 10-days, TTE showed a marked reduction in AV gradients (MG: 12±6 mmHg; p<0.0001), and marked increase in AVA (1.46±0.38 cm2, p<0.0001) vs. pre-procedure; these findings were sustained at the 1-, 3-, 6-, and 12-month follow-up studies (MG fixed-effect time p<0.0001); AVA improved in a similar fashion (all p<0.0001 vs. pre-procedure; figure⇓). PVR immediately post-implantation was present in 12/17 (trivial/mild (1+): 9, moderate (2+): 4, not evaluated 4) and at 1-month in 22/28 (1+: 17; 2+: 5; not evaluated, 2).
Conclusions: Early and intermediate echocardiographic follow-up after PAVR in elderly patients with severe aortic stenosis exhibits good hemodynamic function; although moderate PVR is common, there is no progression in severity.