title: Percutaneous implantation of the self-expandable CoreValve for high risk patients with severe aortic valve stenosis: early Israeli experience.
abstract: BACKGROUND
  The prevalence of aortic stenosis increases with advancing age. Once symptoms occur the prognosis in patients with severe aortic stenosis is poor. The current and recommended treatment of choice for these patients is surgical aortic valve replacement. However, many patients, mainly the very elderly and those with major comorbidities, are considered to be at high surgical risk and are therefore denied treatment. Recently, a transcatheter alternative to surgical AVR has emerged.
  
  
  OBJECTIVE
  To describe the first year experience and 30 day outcome of transcatheter aortic self-expandable CoreValve implantation in Israel.
  
  
  METHODS
  Transcatheter aortic valve implantation using the CoreValve system has been performed in Israel since September 2008. In the following year 55 patients underwent CoreValve TAVI in four Israeli centers.
  
  
  RESULTS
  Patients' mean age was 81.7 +/- 7.1 years; there were 35 females and 20 males. The mean valve area by echocardiogram was 0.63 +/- 0.16 cm2. The calculated mean logistic Euroscore was 19.3 +/- 8%. Following TAVI, mean transvalvular gradient decreased from baseline levels of 51 +/- 13 to 9 +/- 3 mmHg. The rate of procedural success was 98%. One patient died on the first day post-procedure (1.8%) and all-cause 30 day mortality was 5.5% (3 of 55 patients). One patient had a significant post-procedural aortic regurgitation of > grade 2. Symptomatic improvement was evident in most patients, with reduction in functional capacity grade from 3.2 +/- 0.6 at baseline to 1.4 +/- 0.7. The most common post-procedural complication was complete heart block, which necessitated permanent pacemaker implantation in 37% of patients.
  
  
  CONCLUSIONS
  The Israeli first year experience of transcatheter aortic valve implantation using the CoreValve self-expandable system demonstrates an effective and safe procedure for the treatment of severe aortic stenosis in patients at high surgical risk.
authors.affiliation: Department of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Danenberg
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Dan
authors.initials: D
authors.lastname: Gilon
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.forename: Alex
authors.initials: A
authors.lastname: Sagie
authors.forename: Micha
authors.initials: M
authors.lastname: Feinberg
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D007557:Israel; D008297:Male; D011474:Prosthesis Design; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome