Surgical aspects of endovascular retrograde implantation of the aortic CoreValve bioprosthesis in high-risk older patients with severe symptomatic aortic stenosis.

OBJECTIVES: Aortic stenosis is one of the most common forms of acquired valvular heart disease in adults, and the proportion of patients unsuitable for conventional surgery is increasing. Consequently, the development of new less-invasive techniques to treat severe aortic stenosis is crucially important. Current experience in percutaneous aortic valve replacement is limited to a few groups, and the search for an optimal technique continues. We report our experience with retrograde endovascular bioprosthesis implantation with brief cardiopulmonary bypass support in high-risk older patients.
METHODS: The CoreValve pericardial bioprosthesis (CoreValve, Inc, Paris, France) is sutured on a nitinol frame and delivered in a 21F catheter. All procedures were performed under femoro-femoral cardiopulmonary bypass support consisting of an aortic balloon valvuloplasty followed by prosthesis deployment within the aortic annulus under fluoroscopy. Ten high-risk surgical patients underwent percutaneous valve replacement.
RESULTS: Immediate improvement in aortic valve function was observed in all patients. The aortic valve area increased from 0.57 +/- 0.19 to 1.2 +/- 0.35 cm2 (P = .00001), the mean transaortic valve gradient decreased from 51 +/- 19 to 11 +/- 3 mm Hg (P < .001). The 30-day mortality was 20%: one patient died 5 days after the procedure of a massive ischemic stroke and 1 patient died at 20 days of a hemorrhagic stroke. The median New York Heart Association functional class improved from III to II (P = .01).
CONCLUSIONS: Aortic valve replacement with the CoreValve bioprosthesis can be performed with favorable early technical results in high-risk patients. However, the morbidity and short-term mortality of such procedures remain significant.