Transcatheter aortic valve implantation in the operating room: early experience

被引:13
作者
Fusari, Melissa [1 ]
Alamanni, Francesco [1 ]
Bona, Veronica [1 ]
Muratori, Manuela [2 ]
Salvi, Luca [3 ]
Parolari, Alessandro [1 ]
Biglioli, Paolo [1 ]
机构
[1] Ctr Cardiol Monzino IRCCS, Dept Cardiovasc Surg, Milan, Italy
[2] Ctr Cardiol Monzino IRCCS, Dept Cardiol, Milan, Italy
[3] Ctr Cardiol Monzino IRCCS, Dept Intens Care Unit Cardiovasc Surg, Milan, Italy
关键词
aorta; aortic valve replacement; catheter; heart valve; stenosis; HIGH-RISK PATIENTS; PERCUTANEOUS HEART-VALVE; POSITION STATEMENT; REPLACEMENT; PROSTHESIS; STENOSIS; SURGERY; FEASIBILITY; EUROSCORE;
D O I
10.2459/JCM.0b013e328329acf2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective Aortic stenosis is the most common valvular heart disease in the Western world and the proportion of patients unsuitable for conventional surgery is increasing as a result of aging and comorbidities. We report our early experience with transcatheter aortic valve implantation in high-risk patients with severe symptomatic aortic stenosis. Methods Transcatheter Edwards-SAPIEN valve implantation was attempted in 22 patients (80 5 years) in whom surgical risk was deemed excessive because of older age, poor left ventricular function, comorbidities, or all. A retrograde transarterial approach was used in 15 cases. In seven cases, valve implantation was performed by transapical approach because of aortic or iliac artery tortuosity, or both, and stenosis. All procedures were performed without cardiopulmonary bypass. Rapid ventricular pacing was used to reduce cardiac output while delivering balloon-expandable prosthesis. Results One patient died because of aortic dissection during early catheterization maneuvers. In the remaining patients, procedural success was achieved in all cases. Successful valve replacement was associated with an increase in transthoracic echocardiographic valve area from 0.65 +/- 0.14 to 2.2 +/- 0.4 cm(2) and significant improvement in clinical condition. During the course of this experience, we encountered three (13.6%) cases of vascular complications related to transcatheter aortic valve implantation procedures. Conclusion The present study confirms the excellent hemodynamic performances of the transcatheter-implanted aortic prosthesis, with both transarterial and transapical approaches, in inoperable candidates with end-stage aortic stenosis. With progressive improvement in patient selection, techniques, equipment, and operator endovascular skills, vascular complications can decline further. J Cardiovasc Med 10:383-393 (C) 2009 Italian Federation of Cardiology.
引用
收藏
页码:383 / 393
页数:11
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