Percutaneous Aortic Valve Replacement in Patients with Severe Aortic Stenosis and High Surgical Risk

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Abstract

Background: Aortic valve replacement is the treatment of choice in patients with aortic stenosis. However, a significant number of patients are not candidates for surgery due to high surgical risk and to the presence of comorbidities. Percutaneous aortic valve replacement represents an alternative option to conventional aortic valve surgery for selected high risk patients.

Objective: To inform about the initial experience with percutaneous aortic valve replacement with a self-expanding CoreValve aortic valve prosthesis (Medtronic, Minneapolis, MN, USA).

Material and Methods: We conducted a multicenter registry including 21 patients with severe symptomatic aortic stenosis (aortic valve area ≤1 cm2) and high surgical risk undergoing percutaneous aortic valve replacement in four high complexity cardiovascular centers. A multidisciplinary strategy was used involving several specialists: anesthesiologist, surgeon, diagnostic images specialists and interventional cardiologists.

Results: Mean age was 80.8±7.1 years (range: 63-90); 57% were men. Mean aortic valve area was 0.59±0.25 cm2 and mean EuroSCORE was 18.1%±4%. The percentages of patients in functional class III and IV were 73% and 27%, respectively. The procedure was successful in 95.2% (20/21) of patients, with a pronounced reduction in peak transvalvular aortic gradient (from 82±14 mm Hg to 12±3 mm Hg; p <0,001); 14% of patients developed moderate to severe aortic regurgitation after the procedure. 85.5% of patients evolved to FC I. Definite pacemaker implantation was required in 38% (8/21). Procedure-related mortality was 4.7% and mortality after 30 days was 9.5%. One patient developed a minor stroke with complete recovery within a week. Four patients died in the long-term follow-up (median 7 months): 2 due to cardiac causes (cardiac mortality 19%) and 2 due to non-cardiac causes.

Conclusions: Percutaneous aortic valve replacement with CoreValve aortic valve prosthesis is a feasible option for patients with high surgical risk that is associated with significant clinical improvement. The adequate selection of patients, improvement of the surgical technique and the development of new designs will increase the efficacy and safeness of the procedure.