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Clinical Trial
. 2009 Apr;106(14):235-41.
doi: 10.3238/arztebl.2009.0235. Epub 2009 Apr 3.

Valve implantation on the beating heart: catheter-assisted surgery for aortic stenosis

Sabine Bleiziffer  1 , Hendrik Ruge, Domenico Mazzitelli, Christian Schreiber, Andrea Hutter, Markus Krane, Robert Bauernschmitt, Rüdiger Lange
Affiliations
Clinical Trial

Valve implantation on the beating heart: catheter-assisted surgery for aortic stenosis

Sabine Bleiziffer et al. Dtsch Arztebl Int. 2009 Apr.

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.

Keywords: aortic stenosis; aortic surgery; cardiac valve replacement; catheterization; minimally invasive treatment.

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Figures

Figure 1
Figure 1
(a) Edwards-Sapien prosthesis (b) transapical placement (c) transfemoral placement (Reprinted with the kind permission of Edwards Lifesciences, Irvine, California)
Figure 2
Figure 2
(a) Diagram of the CoreValve prosthesis in the aortic root (reprinted with the kind permission of CoreValve, Irvine, California) (b) Release of the CoreValve prosthesis in the beating heart
Figure 3
Figure 3
Kaplan-Meier survival curve after transcatheter valve implantations performed at the German Heart Center, Munich; 30-day survival, 88.2% (134 of 152 patients)
Figure 4
Figure 4
Hemodynamic function of the different types and sizes of valves that can be implanted through catheters; (a) mean gradient, (b) valve orifice area
Figure 5
Figure 5
The number of CoreValve prostheses implanted worldwide as of 31 July 2008 (reprinted with the kind permission of CoreValve, Irvine, California)
See this image and copyright information in PMC

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