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Percutaneous aortic valve replacement for the treatment of aortic stenosis: early experience in Brazil
Marco Antonio Perin1, Fábio Sândoli de Brito, Breno Oliveira Almeida
1Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Insights
Percutaneous aortic valve replacement using the CoreValve device is a feasible option for elderly patients with severe aortic stenosis and high surgical risk. This early experience shows promising results in improving valve function and heart failure symptoms.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Aortic stenosis is a critical condition often affecting elderly patients with comorbidities.
- Traditional surgical aortic valve replacement poses high risks for these patients.
- Percutaneous aortic valve replacement (PAVR) offers a less invasive alternative.
Observation:
- The CoreValve endoprosthesis was used in two elderly patients (77 and 87 years) with symptomatic severe aortic stenosis and high surgical risk (EuroScore 7.7% and 12.1%).
- The patients presented with significant comorbidities, contraindicating conventional surgery.
Findings:
- Successful CoreValve implantation was achieved in both patients.
- Immediate post-procedure results showed significant valve area enlargement and reduction in transvalvular gradients.
- At six months, further gradient reduction (< 20 mmHg) and improvement in heart failure symptoms (NYHA III to NYHA I) were observed.
- Both patients required permanent pacemaker implantation due to atrioventricular block during hospitalization.
Implications:
- PAVR with the CoreValve endoprosthesis is a feasible treatment for severe aortic stenosis in high-risk elderly patients.
- The procedure demonstrates potential for significant hemodynamic improvement and symptom relief.
- Further research and larger studies are warranted to confirm long-term efficacy and safety, including managing potential complications like atrioventricular block.
Background:
Percutaneous aortic valve replacement for the treatment of aortic stenosis is an available and efficient alternative for patients at high surgical risk, especially those with advanced age and comorbidities.
Objective:
The authors report the first experience made in our midst with the use of the CoreValve endoprosthesis.
Methods:
In January 2008, two patients underwent percutaneous aortic valve replacement due to symptomatic aortic stenosis. They were selected for being elderly (77 and 87 years) and presenting comorbidities and a high surgical risk (EuroScore 7.7% and 12.1%).
Results:
Percutaneous implantations of the CoreValve device were successfully performed. Enlargement of the valve area (from 0.7 to 1.5 cm(2) and from 0.5 to 1.3 cm(2)) and reduction of the aortic transvalvular gradient (from 82 to 50 mmHg and from 94 to 31 mmHg) were observed immediately after the intervention. During hospital stay, permanent pacemaker implantation was required in both patients due to atrioventricular block. At six months, an even greater drop in the aortic transvalvular gradient (gradient < 20 mmHg) and remission of symptoms of heart failure (NYHA III to NYHA I) were observed.
Conclusion:
The use of the CoreValve endoprosthesis for the treatment of aortic stenosis proved to be feasible and showed encouraging results in this early experience made in our midst.
