Retrograde endovascular aortic valve replacement: Initial experiences with the CoreValve® prosthesis

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Felderhoff, T, Gerckens, U, Büllesfeld, L, Iversen, S, Grube, E
• Format: Conference Proceeding
• Language: English
• Published: 09.02.2006
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-2006-925737

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.