Hasan Jilaihawi, Tomasz Spyt, Derek Chin, Elaine Logtens, Johann Bence, Jan Kovac.
Glenfield Hospital, Leicester, United Kingdom.
Objective: Significant aortic stenosis is common in the elderly. However, such patients are often declined for or refuse surgery due to perceived risk. We report the first clinical experience in the UK of percutaneous aortic valve replacement via femoral route implanted in a high risk elderly population. We sought to assess its safety and efficacy.
Methods: All patients treated had severe symptomatic aortic stenosis (aortic valve area (AVA) < 1 cm²) and were considered by cardiologists and a cardiac surgeon to be at high risk for conventional surgery although not necessarily surgical rejects. We used the third generation CoreValve aortic revalving system.. Transthoracic echocardiography was used to assess valve function before and after the procedure.
Results: Between 30th January and 13th of December 2007, pAVR was attempted in 27 patients. Mean age was 85.3 ± 4.9 (SD) years with a mean logistic EUROSCORE of 19.9 ± 12.6 (SD) %. Baseline ejection fraction calculated by standard biplane echocardiographic methods was 49.3 ± 10.8 %. Peak and mean AV gradients at baseline were 70.7 ± 27.1 mmHg and 43.7 ± 16.3 mmHg respectively with AVA 0.75 ± 0.19 cm². Four cases were performed under local anaesthesia with sedation and the remainder under general anaesthesia. Mean total procedure time was 124 ± 30 min with actual valve replacement time of 12 ± 12 min. Average post-procedural time to discharge was 5.9 ± 3.8 days.
Predischarge echocardiography revealed a peak gradient of 15.6 ± 6.8 mmHg and a mean of 7.9 ± 3.6 mmHg with AVA 1.5 ± 0.3 cm². For those 23 cases with 30 day dollow-up, there was 1 post-procedural death within 30 days attributed to the effects of general anaesthesia (4.3 %). EF improved from 49.6 ± 11.0 % to 54.7 ± 8.3 % pre-discharge (p=0.006). Significant improvements in NYHA status were observed early post procedure.
Conclusions: Initial experience suggests that pAVR is a safe and effective treatment for severe AS in high risk and elderly patients.
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