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DOI: 10.1055/s-2006-925737
Retrograde endovascular aortic valve replacement: Initial experiences with the CoreValve® prosthesis
Aims: Endovascular aortic valve replacement is an evolving technology in the treatment of aortic valve disease. We present our initial experiences with the self-expanding CoreValve® aortic valve prosthesis.
Methods: The CoreValve® aortic valve prosthesis consists of a bovine pericardial tissue valve (inner diameter 21–22mm) mounted on a self-expanding nitinol stent of 50mm length.
Between February and August 2005 thirteen selected patients (12 female, 1 male with an average age of 78.9 years) with significant aortic valve stenosis underwent endovascular valve replacement.
Immediately following balloon valvuloplasty the prosthesis was delivered retrograde with a 24 Fr. catheter (10 pts.) via a retroperitoneal approach to the common iliac artery or with a 21 Fr. catheter (3 pts.) via the common femoral or subclavian artery after surgical cut-down. For safety reason femoro-femoral extracorporeal circulation was utilized to unload the left ventricle during stent placement.
Results: The prosthesis was successfully implanted within the native aortic valve in 11 patients. Immediate conversion to open surgery due to device displacement was necessary in 2 patients.
Intraoperative echocardiography showed a significant reduction in transaortic mean pressure gradient from 45.7±25.2mmHg to 10.5±5.1mmHg.
Postoperatively four patients died.
Due to procedural platelet activation perioperative antiplatelet aggregation therapy (clopidogrel) is mandatory to avoid thrombocytopenia.
Conclusion: Endovascular aortic valve replacement is technically feasible in selected patients. With further technical and procedural improvements the method may present a valid therapeutic option for patients at high risk for conventional aortic valve surgery.