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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current

Eberhard Grube1, Gerhard Schuler, Lutz Buellesfeld

  • 1HELIOS Heart Center Siegburg, Siegburg, Germany. GrubeE@aol.com

Journal of the American College of Cardiology
|July 3, 2007
PubMed

Insights

Percutaneous CoreValve implantation effectively treats severe aortic stenosis in high-risk patients. This procedure offers a feasible alternative with lower mortality than predicted by risk scores.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Severe symptomatic aortic valve stenosis requires treatment, especially in high-risk or inoperable patients.
  • Percutaneous aortic valve replacement (PAVR) is an emerging alternative therapy.
  • The CoreValve prosthesis offers a solution for patients unsuitable for traditional surgery.

Purpose of the Study:

  • To evaluate the procedural performance and safety of the second (21-French) and third (18-French) generation CoreValve prosthesis.
  • To assess the feasibility of percutaneous aortic valve implantation in high-risk patients.
  • To compare outcomes between the two generations of the CoreValve device.

Main Methods:

  • A total of 86 patients with severe symptomatic aortic valve stenosis were included.
  • Patients met specific criteria based on age, logistic EuroSCORE, and additional risk factors.
  • The study compared outcomes for the 21-French and 18-French CoreValve devices, noting the transition to a less invasive approach with the 18-F device.

Main Results:

  • Acute device success was 88%, with a procedural success rate of 74%.
  • Successful implantation significantly reduced aortic transvalvular gradients (43.7 mm Hg pre-procedure to 9.0 mm Hg post-procedure).
  • Procedural mortality was 6%, with an overall 30-day mortality of 12% and a combined death, stroke, and myocardial infarction rate of 22%.

Conclusions:

  • Percutaneous CoreValve implantation is a feasible treatment for severe aortic valve stenosis in high-risk patients.
  • The procedure is associated with a lower mortality rate than predicted by established risk algorithms.
  • The 18-French device facilitated a transition to a less invasive percutaneous approach.
Abstract

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