title: Novel therapeutic aspects of percutaneous aortic valve replacement with the 21F CoreValve Revalving System.
abstract: OBJECTIVE
  Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We investigated whether novel therapeutic approaches may facilitate AVR outcomes for high-risk patients.
  
  
  RESULTS
  Eleven patients [n = 6 (54%) men] aged 82 +/- 10 years underwent PAVR after being refused for open surgery. The mean+/-SD AV area and left ventricular ejection fraction (LVEF) of these patients was 0.56 +/- 0.19 cm(2) and 49 +/- 17%, respectively, with severe functional limitation (NYHA class III (n = 8) and IV (n = 3)). One patient underwent PAVR combined with simultaneous percutaneous coronary intervention (PCI). Two male patients needed left iliac artery angioplasty. A percutaneous ventricular assist device (PVAD) was used in the most recent case. Compared with pre-PAVR, mean AV area (1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (56 +/- 11%; P < 0.001) increased. One man had a peri-procedural stroke and died 5 days post-PAVR. Four other patients died within 4 months of hospital discharge. The median duration of survival of the survivors was 305 (range 249-431) days.
  
  
  CONCLUSIONS
  Novel percutaneous techniques facilitate CoreValve PAVR (21 Fr.). Future lower profile devices (e.g. 18 Fr. Generation III CoreValve) should permit inclusion of a broader spectrum of high-risk patients. PAVR may evolve toward a full percutaneous approach.
authors: Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
authors: Colin
authors: C
authors: Berry
authors: Anita
authors: A
authors: Asgar
authors: Yoan
authors: Y
authors: Lamarche
authors: Bertrand
authors: B
authors: Marcheix
authors: Pierre
authors: P
authors: Couture
authors: Arsène
authors: A
authors: Basmadjian
authors: Anique
authors: A
authors: Ducharme
authors: Jean-Claude
authors: JC
authors: Laborde
authors: Raymond
authors: R
authors: Cartier
authors: Raoul
authors: R
authors: Bonan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D002170:Canada; D003131:Combined Modality Therapy; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005602:France; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome