Clin Res Cardiol 96: Suppl 1 (2007)

V58 - Treatment of Severe Aortic Stenosis by Percutaneous Aortic Valve Replacement: A Single-Center Experience
A. Linke1, T. Walther2, J.-C. Laborde3, S. Möbius-Winkler1, M. Woinke1, P. Sick1, C. Kaulfersch1, F. W. Mohr2, G.C. Schuler1
1Klinik für Kardiologie, Herzzentrum der Universität Leipzig, Leipzig; 2Klinik für Herzchirurgie, Herzzentrum der Universität Leipzig, Leipzig; 3Clinique Pasteur, Toulouse, Frankreich;
Treatment of aortic stenosis remains an ongoing challenge in older patients, since their perioperative mortality increases due to co-morbidities. The 21 F CoreValve revalving system, which carries a porcine bioprosthesis in a self-expandable nitinol frame was developed to provide an alternative  for patients that are of older age or of higher risk for conventional aortic valve replacement. Therefore, it was the aim of the present study to elucidate whether retrograde, percutaneous aortic valve replacement (PAVR) using the 21 F CoreValve system in older patients with co-morbidities is safe, feasible and associated with an improvement in hemodynamics.
Methods: Patients with symptomatic aortic stenosis (valve surface area < 0.8 cm²), aged = 80 years and/or a Logistic Euroscore = 20% were considered for enrollment. Under general anesthesia and femoral-femoral cardiopulmonary bypass, valvuloplasty was performed followed by CoreValve implantation using an retrograde approach. Clinical events were recorded at 10 and 30 days after PAVR. Transthoracic echocardiography was performed before and at 10 days after CoreValve implantation, respectively, to evaluate instantaneous changes in hemodynamics and short term follow-up of the prosthesis.
Results: A total of 14 patients with a mean age of 82±2 years and a Logistic Euroscore of 22±4 % were enrolled. The 21 F CoreValve prosthesis was successfully implanted in all patients. The mean gradient across the aortic valve markedly declined from 38±3 mmHg before to 13±2 mmHg at 10 days after PAVR. The valve surface area increased from 0.6±0.1 cm² before to 1.4±0.1 cm² after CoreValve implantation. Nine patients had Grade 0 or 1 aortic regurgitation (AR) after PAVR and 5 patients AR up to grade 2+. One patient developed pneumonia and died from sepsis 11 days after PAVR resulting in a 30-day-mortality for the entire study population of 7%.  In one patient, a permanent pacemaker was implanted due to persistent bradycardia and one patient experienced a periprocedural stroke. Among 13 patients surviving to discharge after PAVR, no adverse events occurred within 30 days after leaving the hospital.
Conclusion: PAVR with the CoreValve prosthesis is feasible, safe and results in marked improvement of hemodynamics at short-term follow-up in patients that have a higher risk for conventional aortic valve replacement and older individuals.