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

Marcheix, Bertrand; Lamarche, Yoan; Berry, Colin; Asgar, Anita; Laborde, Jean-Claude; Basmadjian, Arsène; Ducharme, Anique; Denault, André; Bonan, Raoul; Cartier, Raymond

doi:10.1016/j.jtcvs.2007.07.031

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 134, Issue 5 , Pages 1150-1156, November 2007

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

Bertrand Marcheix, MD, MSc
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Yoan Lamarche, MD, MSc
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Colin Berry, MD, PhD
- Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
- Dr Berry was supported by a British Heart Foundation International Fellowship.
Anita Asgar, MD
- Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Jean-Claude Laborde, MD
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
- Drs Bonan and Laborde are consultants to CoreValve, Inc, Paris, France.
Arsène Basmadjian, MD, MSc
- Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Anique Ducharme, MD, MSc
- Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada.
André Denault, MD
- Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
Raoul Bonan, MD
- Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
- Drs Bonan and Laborde are consultants to CoreValve, Inc, Paris, France.
Raymond Cartier, MD
- Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
- Address for reprints: Raymond Cartier, MD, Department of Cardiovascular Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada.

Received 9 February 2007; received in revised form 3 July 2007; accepted 10 July 2007.

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.

CTSNet classification: 20, 35

Abbreviations and Acronyms: AS, aortic stenosis, AVR, aortic valve replacement, PAVR, percutaneous aortic valve replacement, TEE, transesophageal echocardiography