Percutaneous Implantation of Aortic Valve Prosthesis in Patients with Calcific Aortic Stenosis: Technical Advances, Clinical Results and Future Strategies

Abstract

To date, one third of patients with symptomatic aortic stenosis are not operated on because of advanced age, depressed left ventricular function, or comorbidities. Whereas balloon aortic valvuloplasty can be used as a palliative treatment in this population, the hemodynamic and clinical benefits of the procedure are only temporary. With the goal of offering to this subset of patients a nonsurgical therapeutic option with improved results and longer term positive outcomes, we developed a percutaneous implantable bioprosthetic heart valve able to be inserted within the native diseased aortic valve using cardiac catheterization techniques. The first human implant was performed by our group in April 2002 using the antegrade transeptal approach. Since then, we have implanted the valve on compassionate basis in a series of nonsurgical elderly patients with end‐stage aortic stenosis and multiple comorbidities, all declined by cardiac surgeons for valve replacement. This article describes the technical improvements of the device and implantation protocols, provides clinical results of the first series of patients, and outlines strategies for future development of the percutaneous heart valve.

Incidence rate and predictors of permanent pacemaker implantation after transcatheter aortic valve implantation with self-expanding CoreValve prosthesis

“…Transcatheter aortic valve implantation (TAVI) is becoming a viable alternative to open heart surgery in high-risk patients with aortic stenosis [1][2][3][4][5][6]. Despite long-term data on TAVI outcomes remain limited, the procedure is associated to early functional class improvement, with an overall success rate ranging from 74% to 100% [7,8].…”

Percutaneous Aortic Valve Replacement Will Become a Common Treatment for Aortic Valve Disease

“…In a report of the initial 36, primarily transvenous, patients from France, valve implantation was successful in 75% (17). Although problematic, this early transvenous experience did document the feasibility of the procedure and the potential for durable benefit.…”

“…Initial experience with transcatheter valves suggested that paravalvular regurgitation was often severe (2,17,24). With various modifications of the procedure, such severe leaks are infrequent.…”

Offsite anesthesiology in the cardiac catheterization lab

“…The first percutaneous aortic valve replacement was performed in France in 2002 [23]. Early results of this procedure are encouraging [24].…”