Transcatheter aortic valve implantation in the operating room

Early experience

Melissa Fusari, Francesco Alamanni, Veronica Bona, Manuela Muratori, Luca Salvi, Alessandro Parolari, Paolo Biglioli

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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 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.

Original languageEnglish
Pages (from-to)383-393
Number of pages11
JournalJournal of Cardiovascular Medicine
Volume10
Issue number5
DOIs
Publication statusPublished - May 2009

Fingerprint

Operating Rooms
Aortic Valve Stenosis
Prostheses and Implants
Blood Vessels
Comorbidity
Heart Valve Diseases
Western World
Iliac Artery
Cardiopulmonary Bypass
Left Ventricular Function
Catheterization
Cardiac Output
Patient Selection
Dissection
Pathologic Constriction
Hemodynamics
Transcatheter Aortic Valve Replacement
Equipment and Supplies

Keywords

  • Aorta
  • Aortic valve replacement
  • Catheter
  • Heart valve
  • Stenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve implantation in the operating room : Early experience. / Fusari, Melissa; Alamanni, Francesco; Bona, Veronica; Muratori, Manuela; Salvi, Luca; Parolari, Alessandro; Biglioli, Paolo.

In: Journal of Cardiovascular Medicine, Vol. 10, No. 5, 05.2009, p. 383-393.

Research output: Contribution to journalArticle

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N2 - 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 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.

AB - 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 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.

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