Treatment of aortic stenosis remains challenging in older individuals, since their perioperative mortality for conventional aortic valve replacement increases due to co-morbidities. Therefore, it was aim of the present study to elucidate whether retrograde, percutaneous aortic valve replacement (PAVR) using the CoreValve system in older patients (pts) with co-morbidities is safe, feasible and associated with an improvement in hemodynamics.
Methods:
Pts with symptomatic aortic stenosis (valve surface area < 0.8 cm
2
), aged ≥ 75 years and/or a Logistic EuroSCORE ≥ 15 % were considered for enrollment. Using a retrograde approach, valvuloplasty was performed either under local or general anesthesia followed by CoreValve implantation. The CoreValve revalving system carries a porcine pericardial bioprosthesis in a self-expandable nitinol frame. Clinical events were recorded at 30 days after PAVR. Transthoracic echocardiography was performed before and at 10 days after CoreValve implantation to evaluate instantaneous changes in hemodynamics and short term follow-up of the prosthesis.
Results:
A total of 30 pts with a mean age of 83±1 years and a Logistic EuroSCORE of 22±3 % were enrolled. The CoreValve prosthesis was successfully implanted in 28 patients (93%), in two patients a conversion to conventional surgery was necessary due to valve misplacement. The mean gradient across the aortic valve markedly declined from 43±3 mmHg before to 10±2 mmHg at 10 days after PAVR. The valve surface area increased from 0.6±0.1 cm
2
before to 1.6±0.2 cm
2
after CoreValve implantation. Twenty-two pts had grade 0 or 1 aortic regurgitation (AR) after PAVR and 6 patients AR up to grade 2+. Three patients died after successful PAVR, two from sepsis and one from cardiac failure resulting in a 30-day-mortality for the entire study population of 10 %. Three patients (10 %) experienced a periprocedural stroke. Among 25 patients surviving to discharge after successful PAVR, no adverse events occurred within 30 days after leaving the hospital.
Conclusion:
These early results suggest that PAVR with the CoreValve prosthesis is feasible, safe, improves hemodynamics and, therefore, might be an alternative in very high-risk patients for conventional aortic valve replacement.
LBT-1 Transcatheter Aortic Valve Replacement for Patients With Severe Aortic Stenosis Who Are at Low Risk for Mortality: Results From the Prospective Multicenter LRT Clinical Trial
