Outcomes of Direct Implantation of Self-Expandable Aortic Valve Prosthesis for Severe Aortic Stenosis

Abstract

Objective

To describe the initial experience with aortic valve implantation via a direct approach using a self-expanding CoreValveTM aortic valve prosthesis in a tertiary care center from Argentina.

Material and methods
From May to December 2010, 21 consecutive patients with severe aortic stenosis (SAS) and high surgical risk undergoing
percutaneous aortic valve replacement with CoreValveTM prosthesis were included. The inclusion criteria were the
following: aortic valve area <1 cm2 (<0.6 cm2/m2); aortic annulus diameter of 20-27 mm; diameter of the ascending
aorta at the level of the sinotubular junction ≤ 40 (small prosthesis) or ≤ 43 mm (large prosthesis), and femoral artery diameter >6 mm.
Results
Mean age was 79±8 years, mean aortic valve area was 0.7±0.2 cm2 and mean logistic EuroSCORE was 26±15% (50% with
logistic EuroSCORE 3 20%). After valve implantation, peak transaortic pressure gradient measured by echocardiography decreased from 80±22 to 14±5 mm Hg. Two patients developed severe aortic regurgitation which improved with post-dilation. The success rate of the procedure was of 95% as a patient died immediately after valve implant. A definite pacemaker was implanted to six patients due to atrioventricular block. Cumulative survival was 75% after a mean follow-up of 5±2.8 months.

Conclusion
Our initial experience suggests that direct implantation of CoreValveTM prosthesis is a safe and feasible therapeutic option for patients with SAS and high surgical risk.