Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease

Grube, Eberhard; Laborde, Jean Claude; Gerckens, Ulrich; Felderhoff, Thomas; Sauren, Barthel; Buellesfeld, Lutz; Mueller, Ralf; Menichelli, Maurizio; Schmidt, Thomas; Zickmann, B.; Iversen, Stein; Stone, Gregg W.

doi:10.1161/circulationaha.106.639450

Cited by 641 publications

(397 citation statements)

References 22 publications

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“…Atualmente cerca de 25 mil pacientes já foram tratados com esse dispositivo no mundo e a experiência acumulada com o emprego dessas biopróteses em pacientes com contraindicação ou com alto risco cirúrgico indica que os resultados são bastante promissores. [7][8][9][10][11][12] Recentemente, iniciou-se a experiência com o sistema CoreValve TM no Brasil, 13,14 que motivou a criação de um registro nacional para aferir os resultados do implante percutâneo de biopróteses aórticas em nosso meio.…”

Section: Key-wordsunclassified

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Júnior¹,

Siqueira²,

Sarmento‐Leite³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: A substituição cirúrgica da valva aórtica é o tratamento de eleição para pacientes com estenose aórtica acentuada. Entretanto, o risco cirúrgico aumenta expressivamente com o avançar da idade e com a associação de comorbidades. Recentemente, iniciou-se a experiência com o implante por cateter de biopróteses aórticas no Brasil. Justifica-se, portanto, a criação de um registro nacional para conhecimento dos resultados desse tipo de procedimento em nosso meio. Descrevemos o racional e o desenho do Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter. Métodos: Trata-se de um registro multicêntrico, prospectivo, que incluirá 200 pacientes portadores de estenose valvar aórtica sintomática de alto risco cirúrgico submetidos a implante por cateter de bioprótese valvular aórtica em centros brasileiros. O desfecho primário do estudo é a mortalidade por qualquer causa aos 30 dias, 12 meses e 24 meses. Os desfechos secundários avaliados incluem, entre outros: 1) sucesso técnico do implante da bioprótese; 2) mortalidade cardiovascular aos 30 dias, 12 meses e 24 meses; 3) desfecho combinado de segurança aos 30 dias; e 4) desfecho combinado de eficácia aos 12 meses e 24 meses. Conclusões: A análise dos resultados desse registro ABSTRACT Rationale and Design of the Brazilian TranscatheterAortic Valve Implantation Registry

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Section: Key-wordsunclassified

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Júnior¹,

Siqueira²,

Sarmento‐Leite³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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“…The anesthetic technique remains uncertain, as there are schools using the deep sedation technique, others using general anesthesia, and still another school using combined epidural anesthesia with sedation 4,[12][13][14][15][16] . General anesthesia and deep sedation have been used in several studies with good results 4,10,[16][17][18][19][20][21][22][23][24][25][26][27] . In our case series, we used general anesthesia due to the need for prolonged immobilization of patients in uncomfortable tables, tendency for hypothermia, the team's learning curve, need for surgical repair of catheterized arteries, TEE use, possibility of neurological complications and surgical intervention with cardiopulmonary bypass (CPB), and little knowledge on the technique.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, several clinical trials with different devices have been reported 4 . There are currently two types of prostheses for clinical use: CoreValve (Medtronic Inc., Minneapolis, MN) and Edwards-Sapien (Edwards Life Sciences Inc., Irvine, CA) 3,[5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Manejo anestésico e complicações no implante percutâneo de válvula aórtica

Grando¹,

Sarmento‐Leite²,

Prates³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objective: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. Method: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM), electrocardiogram (ECG), pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. Results: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe. Conclusion: The initial experience with percutaneous aortic valve implantation under general anesthesia has proven to be safe and effective, with no signifi cant anesthetic complications during this procedure.

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“…A self-expanding prosthetic valve can be deployed percutaneously via a retrograde approach in approximately 84-93% of patients. When successfully implanted, it increases aortic valve area, reduces transvalvular gradients, and improves New York Heart Association functional class, but major adverse cardiac events occurred in as many as 32% of patients at short term follow-up, which included death in 20% [10][11][12]. The largest trial to date which included 86 patients reported a procedural mortality of 6%, a 30-day mortality of 12%, and a cumulative incidence of death, stroke, and myocardial infarction of 22% [12].…”

Section: Discussionmentioning

confidence: 99%

Palliative Combined Percutaneous Balloon Aortic Valvuloplasty and Unprotected Left Main Stenting in End Stage Renal Disease

Dorfman¹,

Aqel²

2009

CCR

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Abstract:With the aging population and high prevalence of atherosclerosis, an increasing number of patients presenting with heart failure and angina are found to have severe coronary artery disease and severe valvular disease. These patients tend to have multiple co-morbidities such as end stage renal disease and are considered high-risk for surgery. In patients with severe coronary artery disease, severe aortic stenosis, and heart failure with depressed left ventricular systolic function, the options are limited as they are not usually offered surgery, but palliative percutaneous high-risk procedures might be a viable alternative.Though long term results after balloon aortic valvuolpasty are not promising, there is a role for these procedures in highrisk inoperable patients for either palliation or as a bridge to surgery. Unprotected left main percutaneous interventions are also feasible with low complication rates. This review provides mounting evidence that it is reasonable to perform combined palliative balloon aortic valvuolpasty and high-risk coronary artery stenting in certain inoperable patients. An illustrative case is presented that extends the findings of the current literature and demonstrates that combined balloon aortic valvuolpasty and left main stenting could be a safe and effective alternative in the setting of heart failure, left ventricular dysfunction, and end stage renal disease.Keywords: Aortic stenosis, critical left main disease, percutaneous balloon aortic valvuoplasty, unprotected left main stenting, palliative high risk percutaneous interventions. CASE REPORTA 56 year-old African American female with end stage renal disease on hemodialysis was admitted for worsening dsypnea and exertional chest pain. Her shortness of breath had begun 1-2 years ago but had progressed rapidly over the past few months. Presently she has dyspnea on exertion with minimal activity, severe orthopnea, paroxysmal nocturnal dyspnea, and marked peripheral edema and was considered to be in New York Heart Association class IV heart failure.Past medical history was notable for congestive heart failure with preserved left ventricular (LV) function, end stage renal disease on hemodialysis, systemic arterial hypertension, and diabetes type 2. On admission the patient was on a beta blocker, ace inhibitor, non-dihydropyridine calcium channel blocker, hydralazine, a statin, and aspirin.She was afebrile with a heart rate of 94 beats/min, blood pressure 148/75 mm Hg, and a respiratory rate 28 breaths/min with 94% oxygen saturation on room air. Her exam was otherwise notable for jugular venous pressure at about 13 cm H 2 0, delayed carotid upstrokes, and bibasilar crackles. Cardiac exam was notable for a normal S1 and a soft P2, a focal, non-displaced point of maximal impulse with no lifts, heaves, or thrills, and a III/VI systolic ejection murmur that peaked late in systole and was audible at the Transthoracic echocardiography revealed a LV ejection fraction of 35%, preserved right ventricular function, mild mitral regurgit...

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Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve Disease

Cited by 641 publications

References 22 publications

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Manejo anestésico e complicações no implante percutâneo de válvula aórtica

Palliative Combined Percutaneous Balloon Aortic Valvuloplasty and Unprotected Left Main Stenting in End Stage Renal Disease

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