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  • Title: Transcatheter aortic valve implantation in patients with very high risk for conventional aortic valve replacement.
    Author: Thielmann M, Wendt D, Eggebrecht H, Kahlert P, Massoudy P, Kamler M, Erbel R, Jakob H, Sack S.
    Journal: Ann Thorac Surg; 2009 Nov; 88(5):1468-74. PubMed ID: 19853095.
    Abstract:
    BACKGROUND: We sought to determine whether transcatheter aortic valve implantation is a reasonable treatment option in patients with a very or extremely high risk for conventional aortic valve replacement, presenting with a logistic EuroSCORE greater than 30% or a Society of Thoracic Surgeons score greater than 15%. METHODS: Between May 2005 and November 2008, 39 of 85 transcatheter aortic valve implantation patients with a very high risk for aortic valve replacement underwent either transfemoral (n = 15) or transapical (n = 24) transcatheter aortic valve implantation with a mean estimated logistic EuroSCORE of 44.2% +/- 12.6% (mean +/- standard deviation) and a Society of Thoracic Surgeons score of 17.9% +/- 6.1%. Transcatheter aortic valve implantation was performed in a hybrid operative theater using the Cribier-Edwards or Edwards SAPIEN prosthesis. RESULTS: Valve implantation was successful in 97% of the patients. Operative mortality was 2.6%, and mortality at 30 days was 17.9%. After valve implantation, hemodynamic improvement was assessed by decreased mean pressure gradient (p < 0.001) and increased aortic valve area (p < 0.001), accompanied by improved New York Heart Association functional status (p < 0.01). Actuarial survival was 74.4% at 3 months, 74.4% at 6 months, and 64.1% at 12 months of follow-up. Echocardiography revealed aortic regurgitation in 58% of the patients during hospital stay, 43% at 6 months of follow-up, and 40% at 12 months of follow-up, but no structural valve deterioration could be observed during the complete follow-up period. CONCLUSIONS: Transcatheter aortic valve implantation in patients with severe aortic stenosis and a very high risk for aortic valve replacement is feasible and may be a reasonable treatment option in these patients.
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