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[Percutaneous aortic valve replacement - initial experience and results]
Lene Kjaer Olsen1, Thomas Engstrøm, Kristian Wachtell
1Kardiologisk Klinik B 2014, Rigshospitalet, DK-2100 København Ø.
Insights
Percutaneous aortic valve replacement offers a promising new treatment for patients with inoperable aortic stenosis (AS). This study shows successful valve implantation with significant symptom relief and improved aortic valve function in a small patient cohort.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Context:
- Aortic stenosis (AS) is a prevalent valvular heart disease with significant morbidity and mortality.
- Surgical valve replacement is standard for symptomatic AS, but many patients are inoperable.
- Inoperable patients with severe AS require alternative treatment options.
Purpose:
- To evaluate the outcomes of percutaneous aortic valve replacement (PAVR) in patients with inoperable severe AS.
- To assess the safety and efficacy of the CoreValve ReValving System in this patient population.
Summary:
- Twenty inoperable AS patients received the CoreValve prosthesis, achieving 100% procedural success.
- Significant improvements were observed in aortic valve area and pressure gradients post-procedure.
- 30-day mortality was 5%, with permanent pacemaker implantation (25%) being the most frequent complication.
Impact:
- PAVR demonstrates potential as a crucial therapeutic option for inoperable AS patients.
- These findings align with international experiences, suggesting broader applicability.
- The study provides early evidence supporting PAVR's role in managing severe, inoperable aortic stenosis.
Introduction:
Aortic stenosis (AS) is the most common heart valvular disease and with progressive disease morbidity and mortality are substantial. The standard treatment in symptomatic patients is surgical valve replacement. However, one third of the patients with severe AS are inoperable due to advanced age and comorbidity. The aim of this study was to evaluate the results of percutaneous aortic valve replacement - a new treatment modality for patients with inoperable AS.
Material And Methods:
A total of 20 patients were treated with CoreValve ReValving System valve prosthesis at the Copenhagen University Hospital in the period November 2007 to September 2008.
Results:
The procedural success was 100% and 30-day mortality was 5%, none of which was due to cardiac death. The treatment resulted in a considerable relief of symptoms. The aortic valve area showed a significant increase from 0.8 +/- 0.2 cm(2) to 1.9 +/- 0.6 cm(2) (p < 0.01). There was a significant decrease in the peak pressure gradient across the aortic valve from 75 +/- 38 mm Hg to 18 +/- 8 mm Hg (p < 0.01). Permanent pacemaker due to AV block was the most common complication with an incidence of 25% during the 30-day follow-up.
Conclusion:
Implantation of a percutaneous aortic valve can be achieved in patients with inoperable AS and may become a very important therapeutic modality for this group of patients. These first results from Copenhagen University Hospital are promising and in concordance with international experience.
