Percutaneous aortic valve implantation retrograde from the femoral artery.
BACKGROUND
Percutaneous aortic valve implantation by an antegrade transvenous approach has been described but is problematic. Retrograde prosthetic aortic valve implantation via the femoral artery has potential advantages. Percutaneous prosthetic aortic valve implantation via the femoral arterial approach is described and the initial experience reported.


RESULTS
The valve prosthesis is constructed from a stainless steel stent with an attached trileaflet equine pericardial valve and a fabric cuff. After routine aortic balloon valvuloplasty, a 22F or 24F sheath is advanced from the femoral artery to the aorta. A steerable, deflectable catheter facilitates manipulation of the prosthesis around the aortic arch and through the stenotic valve. Rapid ventricular pacing is used to reduce cardiac output while the delivery balloon is inflated to deploy the prosthesis within the annulus. Percutaneous aortic prosthetic valve implantation was attempted in 18 patients (aged 81+/-6 years) in whom surgical risk was deemed excessive because of comorbidities. Iliac arterial injury, seen in the first 2 patients, did not recur after improvement in screening and access site management. Implantation was successful in 14 patients. After successful implantation, the aortic valve area increased from 0.6+/-0.2 to 1.6+/-0.4 cm2. There were no intraprocedural deaths. At follow-up of 75+/-55 days, 16 patients (89%) remained alive.


CONCLUSIONS
This initial experience suggests that percutaneous transarterial aortic valve implantation is feasible in selected high-risk patients with satisfactory short-term outcomes.
Webb
John G
JG
Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. webb@providencehealth.bc.ca
Chandavimol
Mann
M
Thompson
Christopher R
CR
Ricci
Donald R
DR
Carere
Ronald G
RG
Munt
Brad I
BI
Buller
Christopher E
CE
Pasupati
Sanjeevan
S
Lichtenstein
Samuel
S
D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001021:Aortic Valve; D001705:Bioprosthesis; D002404:Catheterization / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006736:Horses; D006801:Humans; D008297:Male; D016896:Treatment Outcome