title: Valve implantation on the beating heart: catheter-assisted surgery for aortic stenosis.
abstract: BACKGROUND
  For an increasing number of patients with severe symptomatic aortic stenosis, advanced age and comorbidity make the risk of surgery unacceptably high. In such cases, catheter-based techniques for aortic valve implantation are a new therapeutic option. In this paper, we describe the initial results obtained at the German Heart Center, Munich, with a new technique of this kind.
  
  
  METHODS
  From June 2007 to September 2008, 152 patients underwent transcatheter aortic valve implantation at the German Heart Center, Munich (121 transfemorally, 26 transapically, and 5 through other sites of access). In this technique, a stent-mounted valve is crimped onto a catheter and then positioned and deployed in the aortic annulus under fluoroscopic control.
  
  
  RESULTS
  The 30-day mortality was 11.8% in this group of patients at high risk. The more common post-procedural complications were third-degree atrioventricular block leading to pacemaker implantation (31/152, 20%), vascular complications (25/152, 16%), and cerebrovascular events (8/152, 5%). Six months after the procedure, the patients had recovered clinically to a considerable extent, and the implanted prostheses exhibited good hemodynamic function.
  
  
  CONCLUSIONS
  The technical feasibility of catheter-based aortic valve implantation has been demonstrated at multiple centers around the world. Its indications still need to be refined on the basis of the short- and long-term results of the randomized and observational studies that are currently in progress. It is already apparent that catheter-based aortic valve implantation can bring about clinical improvement in patients who are deemed ineligible for open surgery.
authors: Klinik für Herz- und Gefässchirurgie Deutsches Herzzentrum München Lazarettstr. 36 80636 München, Germany. bleiziffer@dhm.mhn.de
authors: Sabine
authors: S
authors: Bleiziffer
authors: Hendrik
authors: H
authors: Ruge
authors: Domenico
authors: D
authors: Mazzitelli
authors: Christian
authors: C
authors: Schreiber
authors: Andrea
authors: A
authors: Hutter
authors: Markus
authors: M
authors: Krane
authors: Robert
authors: R
authors: Bauernschmitt
authors: Rüdiger
authors: R
authors: Lange
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome