Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis

Background - Percutaneous aortic valve replacement represents an endovascular alternative to conventional open heart surgery without the need for sternotomy, aortotomy, or cardiopulmonary bypass. Methods and Results - Transcatheter implantation of a balloon- expandable stent valve using a femoral arterial approach was attempted in 50 symptomatic patients with severe aortic stenosis in whom there was a consensus that the risks of conventional open heart surgery were very high. Valve implantation was successful in 86% of patients. Intraprocedural mortality was 2%. Discharge home occurred at a median of 5 days ( interquartile range, 4 to 13). Mortality at 30 days was 12% in patients in whom the logistic European System for Cardiac Operative Risk Evaluation risk score was 28%. With experience, procedural success increased from 76% in the first 25 patients to 96% in the second 25 ( P = 0.10), and 30- day mortality fell from 16% to 8% ( P = 0.67). Successful valve replacement was associated with an increase in echocardiographic valve area from 0.6 +/- 0.2 to 1.7 +/- 0.4 cm(2). Mild paravalvular regurgitation was common but was well tolerated. After valve insertion, there was a significant improvement in left ventricular ejection fraction ( P < 0.0001), mitral regurgitation ( P = 0.01), and functional class ( P < 0.0001). Improvement was maintained at 1 year. Structural valve deterioration was not observed with a median follow- up of 359 days. Conclusion - Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high- risk patients with severe symptomatic aortic stenosis.