Transcatheter Aortic Valve Implantation without Balloon Predilation: A Single-Center Pilot Experience

AIM:

To assess the results of transcatheter aortic valve
implantation (TAVI) using the Medtronic CoreValve prosthesis (Medtronic,
Minneapolis, MN), without balloon predilation, in high-risk patients
with degenerated severe aortic stenosis.

METHODS AND RESULTS:

Fifty-one
consecutive patients who underwent direct TAVI, 98% through a
transfemoral approach. Patients were 79 ± 8 years of age, 74% in New
York Heart Association classes III or IV and at high risk for surgical
valve replacement (mean logistic EuroScore 20 ± 15). Mean aortic valve
area was 0.7 ± 0.2 cm² . Procedural success rate was 94.2%.
In-hospital, there were 2 deaths, 1 minor stroke with minimal sequelae,
and 14 (28%) pacemaker implantation. At 30 days, there was one
additional stroke and no new deaths. The mean postprocedural
transprosthetic gradient was 15 ± 5 mm Hg; periprosthetic severe
regurgitation was absent and moderate in one case. After a median
follow-up of 7 months, there were five additional deaths (two cardiac),
while 84% of survivors were in New York Heart Association classes I or
II.

CONCLUSIONS:

These results suggest that direct
CoreValve implantation in patients with severe aortic stenosis is
feasible and may lead to hemodynamic and clinical improvement in
patients who are poor candidates for aortic valve surgery, pending
confirmation in larger series with longer follow-up.