Valve implantation on the beating heart: catheter-assisted surgery for aortic stenosis

Background: For an increasing number of patients with severe symptomatic aortic stenosis, advanced age and comorbidity make the risk of surgery unacceptably high. In such cases, catheter-based techniques for aortic valve implantation are a new therapeutic option. In this paper, we describe the initial results obtained at the German Heart Center, Munich, with a new technique of this kind.

Methods: From June 2007 to September 2008, 152 patients underwent transcatheter aortic valve implantation at the German Heart Center, Munich (121 transfemorally, 26 transapically, and 5 through other sites of access). In this technique, a stent-mounted valve is crimped onto a catheter and then positioned and deployed in the aortic annulus under fluoroscopic control.

Results: The 30-day mortality was 11.8% in this group of patients at high risk. The more common post-procedural complications were third-degree atrioventricular block leading to pacemaker implantation (31/152, 20%), vascular complications (25/152, 16%), and cerebrovascular events (8/152, 5%). Six months after the procedure, the patients had recovered clinically to a considerable extent, and the implanted prostheses exhibited good hemodynamic function.

Conclusions: The technical feasibility of catheter-based aortic valve implantation has been demonstrated at multiple centers around the world. Its indications still need to be refined on the basis of the short- and long-term results of the randomized and observational studies that are currently in progress. It is already apparent that catheter-based aortic valve implantation can bring about clinical improvement in patients who are deemed ineligible for open surgery.