Clinical InvestigationValvular and Congenital Heart DiseaseTranscatheter aortic valve implantation for severe aortic stenosis—a new paradigm for multidisciplinary intervention: A prospective cohort study
Section snippets
Patient population
The study is based on a registry prospectively including all patients undergoing TAVI at King's Health Partners from August 2007 to September 2009. Transcatheter aortic valve implantation has been approved for use in patients with symptomatic severe AS who are deemed unfit for conventional, surgical aortic valve replacement (logistic EuroSCORE >20 or Society of Thoracic Surgeons (STS) score >10% or turned down by 2 separate cardiothoracic surgeons). The United Kingdom National Institutes for
Results
The baseline clinical characteristics are shown in Table I. Most patients were >75 years old (87.4%, mean age 82.6 years). Echocardiographic features are consistent with severe AS in all cases: mean peak pressure gradient of 79.2 ± 25.5 mm Hg, mean gradient of 49.7% ± 11.5%, and mean aortic valve orifice area of 0.62 ± 0.16 cm2. The majority had isolated AS with concomitant mitral regurgitation (≥moderate) and aortic regurgitation (≥moderate) in only 16% and 10.6%, respectively. Most patients
Discussion
Percutaneous catheter-based approaches to the treatment of valve disease have been studied in animal models for several years, but it was Bonhoeffer et al9 who performed the first human percutaneous valve implantation (in the pulmonary position) in 2000. Aortic valve implantation was achieved shortly after this in 2002 by Alan Cribier.10 The Edwards-Sapien bioprosthesis has now been approved for clinical use in the European Union and preliminary guidance for its use has been published by the
Acknowledgements
We would like to thank our cardiac anesthetic colleagues Dr Emma Alcock, Dr Kailasam Rajagopal, Dr Amit Chawla, and Dr Andrej Wielogorski for their expert clinical assistance with these challenging cases.
R. D. is a visiting Fellow from I Department of Cardiology, Medical University of Gdansk, Poland. All authors drafted the article and approved the final version. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility
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