Percutaneous implantation of the CoreValve® self-expanding valve prosthesis in patients with severe aortic stenosis and porcelain aorta: medium-term follow-up.
OBJECTIVE
There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve(®) implantation in patients with severe aortic stenosis, with and without porcelain aorta.


METHODS
In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years.


RESULTS
Patients with porcelain aorta more frequently had extracardiac vascular disease (11 [30.6%] vs 49 [11.9%]; P=.002), prior coronary revascularization (15 [41.7%] vs 98 [23.7%]; P=.017), and dyslipidemia (26 [72.2%] vs 186 [45%]; P=.02). In these patients, there was greater use of general anesthesia (15 [41.7%] vs 111 [16.9%]; P=.058) and axillary access (9 [25%] vs 34 [8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 [19.4%] vs 48 [11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 [22.2%] vs 66 [16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001).


CONCLUSIONS
In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve(®) self-expanding valve prosthesis is safe and feasible.
Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Isaac
I
Pascual
Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Pablo
P
Avanzas
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Antonio J
AJ
Muñoz-García
Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Diego
D
López-Otero
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Manuel F
MF
Jimenez-Navarro
Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Belén
B
Cid-Alvarez
Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
Raquel
R
del Valle
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
Juan H
JH
Alonso-Briales
Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Raimundo
R
Ocaranza-Sanchez
Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
Fernando
F
Alfonso
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
José M
JM
Hernández
Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Ramiro
R
Trillo-Nouche
Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. Electronic address: cesarmoris@gmail.com.
César
C
Morís
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
AoP; Aorta de porcelana; Aortic stenosis; CoreValve(®); Estenosis aórtica; Porcelain aorta; TAVI; porcelain aorta; transcatheter aortic valve implantation