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J Thorac Cardiovasc Surg 2007;134:1150-1156
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

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

Bertrand Marcheix, MD, MSca, Yoan Lamarche, MD, MSca, Colin Berry, MD, PhDb,2, Anita Asgar, MDb, Jean-Claude Laborde, MDc,1, Arsène Basmadjian, MD, MScb, Anique Ducharme, MD, MScd, André Denault, MDe, Raoul Bonan, MDb,1, Raymond Cartier, MDa,*

a Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
b Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
e Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
c Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
d Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada.

Received for publication February 9, 2007; revisions received July 3, 2007; accepted for publication July 10, 2007.

* Address for reprints: Raymond Cartier, MD, Department of Cardiovascular Surgery, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada. (Email: rc2910{at}aol.com).

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.

Abbreviations and Acronyms AS = aortic stenosis; AVR = aortic valve replacement; PAVR = percutaneous aortic valve replacement; TEE = transesophageal echocardiography


Related Article

Percutaneous aortic valve replacement with the CoreValve bioprosthesis
Rachid Zegdi, Paul Achouh, and Jean-Noël Fabiani
J. Thorac. Cardiovasc. Surg. 2008 135: 1407-1408. [Extract] [Full Text] [PDF]



This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Zegdi, P. Achouh, and J.-N. Fabiani
Percutaneous aortic valve replacement with the CoreValve bioprosthesis.
J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1407 - 1408.
[Full Text] [PDF]


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