Transcatheter aortic valve implantation in patients with very high risk for conventional aortic valve replacement.
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.
Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany. matthias.thielmann@uni-due.de
Matthias
M
Thielmann
Daniel
D
Wendt
Holger
H
Eggebrecht
Philipp
P
Kahlert
Parwis
P
Massoudy
Markus
M
Kamler
Raimund
R
Erbel
Heinz
H
Jakob
Stefan
S
Sack
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors