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Published on: May 21, 2017
Valve implantation on the beating heart: catheter-assisted surgery for aortic stenosis
Sabine Bleiziffer1, Hendrik Ruge, Domenico Mazzitelli
1Klinik für Herz- und Gefässchirurgie Deutsches Herzzentrum München Lazarettstr. 36 80636 München, Germany. bleiziffer@dhm.mhn.de
Insights
Transcatheter aortic valve implantation offers a new option for patients with severe aortic stenosis who are too high-risk for surgery. Initial results show clinical improvement and good prosthesis function, despite some procedural complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Severe symptomatic aortic stenosis poses high surgical risks for elderly and comorbid patients.
- Catheter-based aortic valve implantation presents a novel therapeutic alternative.
- This study reports initial outcomes of a new catheter-based technique.
Purpose of the Study:
- To evaluate the initial results of transcatheter aortic valve implantation (TAVI).
- To assess the feasibility and early outcomes of TAVI in high-risk patients.
Main Methods:
- 152 patients underwent TAVI between June 2007 and September 2008.
- Procedures included transfemoral, transapical, and other access routes.
- A stent-mounted valve was crimped onto a catheter, positioned, and deployed in the aortic annulus under fluoroscopic guidance.
Main Results:
- 30-day mortality was 11.8% in this high-risk cohort.
- Common complications included atrioventricular block (20%), vascular issues (16%), and cerebrovascular events (5%).
- Significant clinical recovery and good hemodynamic function of implanted valves were observed at 6 months.
Conclusions:
- Catheter-based aortic valve implantation is technically feasible.
- Refinement of indications requires ongoing randomized and observational studies.
- TAVI demonstrates potential for clinical improvement in patients unsuitable for open surgery.
Background:
For an increasing number of patients with severe symptomatic aortic stenosis, advanced age and comorbidity make the risk of surgery unacceptably high. In such cases, catheter-based techniques for aortic valve implantation are a new therapeutic option. In this paper, we describe the initial results obtained at the German Heart Center, Munich, with a new technique of this kind.
Methods:
From June 2007 to September 2008, 152 patients underwent transcatheter aortic valve implantation at the German Heart Center, Munich (121 transfemorally, 26 transapically, and 5 through other sites of access). In this technique, a stent-mounted valve is crimped onto a catheter and then positioned and deployed in the aortic annulus under fluoroscopic control.
Results:
The 30-day mortality was 11.8% in this group of patients at high risk. The more common post-procedural complications were third-degree atrioventricular block leading to pacemaker implantation (31/152, 20%), vascular complications (25/152, 16%), and cerebrovascular events (8/152, 5%). Six months after the procedure, the patients had recovered clinically to a considerable extent, and the implanted prostheses exhibited good hemodynamic function.
Conclusions:
The technical feasibility of catheter-based aortic valve implantation has been demonstrated at multiple centers around the world. Its indications still need to be refined on the basis of the short- and long-term results of the randomized and observational studies that are currently in progress. It is already apparent that catheter-based aortic valve implantation can bring about clinical improvement in patients who are deemed ineligible for open surgery.
