Percutaneous Aortic Valve Replacement Will Become a Common Treatment for Aortic Valve Disease
John G. Webb, MD1,*
Division of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada.
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Figure 1 Transcatheter Valves
(A) The balloon-expandable Edwards SAPIEN valve incorporates a stainless steel stent, bovine pericardial leaflets, and a fabric sealing cuff. (B) The self-expanding CoreValve device incorporates a nitinol (nickel titanium) alloy stent with leaflets and a sealing cuff constructed of porcine pericardial tissue.
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Figure 2 Percutaneous Access and Closure
(Left) Needle puncture of the common femoral artery was followed by placement of percutaneous arterial sutures before insertion of a large 24-F internal diameter (9 mm external diameter) sheath. After valve implantation, a knot pusher is used to advance the sutures knots through the subcutaneous tissues to artery. (Right) Hemostasis was achieved immediately after sheath removal without the need for surgical exposure of the artery. Future reduction in sheath diameter is anticipated to make percutaneous closure more routine.
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Figure 3 Outcomes in the Initial Vancouver Transarterial Percutaneous Balloon Expandable Aortic Valve Replacement First-in-Man Series
Success rates and mortality improved in the second half of the experience (10). Logistic EuroSCORE (19) is an estimate of 30-day mortality after surgery but might overestimate mortality in some high-risk patients.
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