title: Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis.
abstract: BACKGROUND
  Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass.
  
  
  RESULTS
  Transcatheter implantation of a balloon-expandable stent valve using a femoral arterial approach was attempted in 50 symptomatic patients with severe aortic stenosis in whom there was a consensus that the risks of conventional open heart surgery were very high. Valve implantation was successful in 86% of patients. Intraprocedural mortality was 2%. Discharge home occurred at a median of 5 days (interquartile range, 4 to 13). Mortality at 30 days was 12% in patients in whom the logistic European System for Cardiac Operative Risk Evaluation risk score was 28%. With experience, procedural success increased from 76% in the first 25 patients to 96% in the second 25 (P=0.10), and 30-day mortality fell from 16% to 8% (P=0.67). Successful valve replacement was associated with an increase in echocardiographic valve area from 0.6+/-0.2 to 1.7+/-0.4 cm2. Mild paravalvular regurgitation was common but was well tolerated. After valve insertion, there was a significant improvement in left ventricular ejection fraction (P<0.0001), mitral regurgitation (P=0.01), and functional class (P<0.0001). Improvement was maintained at 1 year. Structural valve deterioration was not observed with a median follow-up of 359 days.
  
  
  CONCLUSIONS
  Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high-risk patients with severe symptomatic aortic stenosis.
authors.affiliation: Division of Cardiology, St Paul's Hospital and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada. webb@providencehealth.bc.ca
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Pasupati
authors.forename: Karin
authors.initials: K
authors.lastname: Humphries
authors.forename: Christopher
authors.initials: C
authors.lastname: Thompson
authors.forename: Lukas
authors.initials: L
authors.lastname: Altwegg
authors.forename: Robert
authors.initials: R
authors.lastname: Moss
authors.forename: Ajay
authors.initials: A
authors.lastname: Sinhal
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
authors.forename: Brad
authors.initials: B
authors.lastname: Munt
authors.forename: Donald
authors.initials: D
authors.lastname: Ricci
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: Sam V
authors.initials: SV
authors.lastname: Lichtenstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014463:Ultrasonography