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Percutaneous Aortic Valve Replacement without Predilatation for Symptomatic Severe Aortic Stenosis in High-Risk

PatientsLev G, Valdivieso L, Fava C, Caponi G, Hidalgo G,

Mendiz O. Favaloro Foundation University Hospital. Buenos Aires.

Argentina.

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CoreValve Primario

Background

Since the beginning of percutaneous

Aortic valve replacement was considered

that the previous balloon valvuloplasty

was essential to facilitate optimal

implant and expansion.

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CoreValve Primario

BackgroundThe procedure has a certain risk of

stroke and valvuloplasty may have an

important responsibility.

The rapid pacing for valvuloplasty can

have deleterious effect mainly the pts

with ventricular dysfunction.

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Primary Aortic Valve Replacement

AIMTo assess the in-hospital and follow-up results

of the primary (without predilatation)

percutaneous aortic valve replacement with

the selfexpandable Nitinol CoreValve device

(Medtronic®), in patients with symptomatic

aortic valve severe stenosis and high surgery

risk.

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• Between march 2009 and december 2011, 57 consecutive patients (ptes) with symtomatic severe aortic valve stenosis were treated with CoreValve device.

• 48 ptes (84%) with primary elective implantation.

Primary Aortic Valve Replacement

Materials and Methods

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Primary Aortic Valve Replacement

Material and MethodsCharacteristic n=48 ptes

Age (years) 79±8

Males (%) 30 (63)

21% 19%27%

13%

0%

10%

20%

30%

Hypertension Diabetes Tabaquism Dyslipemia

Cardiovascular risk factors

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Primary Aortic Valve Replacement

Material and Methods

Variable n=48 ptes

Personal history

AMI (%) 10 (21)

CABG (%) 9 (19)

PTCA (%) 13 (27)

Chronic renal failure (%) 6 (13)

Severe COPD (%) 8 (17)

E.F.< 40% (%) 4 (8)

Stroke (%) 5 (10)

Logistic Euroscore 20±15

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Primary Aortic Valve Replacement

Material and MethodsComplementary Studies

Variable n=48 ptes

ECG

Sinusal rythm (%) 43 (90)

Sinusal rythm+1º AVB (%) 1 (2)

Sinusal rhythm + RBBB (%) 1 (2)

Atrial fibrilation(%) 2 (4)

Pacemaker rythm (%) 1 (2)

Echo-Doppler

Mitral insufficiency grade 3-4 (%) 4 (8)

Aortic valve ring (mm) 22±3

Severe grade aortic valve calcification (%) 30 (63)

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• CoreValve´s primary implantation was succesfully achieved in 48 ptes:–Predilatation was requiered in 1 patient

because of extremely asymetric valve expansion.

–Postdilatation was necessary in 15 ptes (31%).

Primary Aortic Valve Replacement

Results

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Variable n=48

Procedure succeed (%) 46 (96)

MACE (%) 2 (4)

Death (%) 2 (4)

Cardiac failure(%) 15 (31)

Minor Stroke(%) 1 (2)

Right ventricle perforation treated with pericardiocentesis (%)

3 (6)

Acute renal failure (%) 2 (4)

Permanent pacemaker (%) 13 (27)

AV Complete block (%) 10 (21)

Left bundle branck block (%) 17 (35)

Final moderate aortic valve insuficiency(%) 20 (42)

Final mild aortic valve insuficiency(%) 27 (56)

Primary Aortic Valve Replacement

30 days Results

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Primary Aortic Valve Replacement

Follow-up Results

Variable n=46

Follow-up period (2-35 months) 12±11

Death of any cause (%) 5 (11)

AMI(%) 1(2)

Minor Stroke (%) 1 (2)

Permanent pacemaker (%) 1 (2)

Asymtomatics (%) 39 (85)

Echo-Doppler n=41

Well-function valve(%) 41 (100)

Mild aortic valve insufficiency (%) 30 (73)

Moderate aortic valve insufficiency (%) 11 (27)

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The percutaneous aortic valve

replacement without predilatation with

the self expandable Nitinol device was

safe and efective with low Stroke

incidence.

Primary Aortic Valve Replacement

Conclusión