Implante percutáneo de la válvula autoexpandible CoreValve en pacientes con estenosis aórtica grave y aorta de porcelana: seguimiento a medio plazo

Introduction and objectives

There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve^® implantation in patients with severe aortic stenosis, with and without porcelain aorta.

Methods

In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years.

Results

Patients with porcelain aorta more frequently had extracardiac vascular disease (11 30.6%] vs 49 11.9%]; P=.002), prior coronary revascularization (15 41.7%] vs 98 23.7%]; P=.017), and dyslipidemia (26 72.2%] vs 186 45%]; P=.02). In these patients, there was greater use of general anesthesia (15 41.7%] vs 111 16.9%]; P=.058) and axillary access (9 25%] vs 34 8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 19.4%] vs 48 11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 22.2%] vs 66 16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001).

Conclusions

In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve^® self-expanding valve prosthesis is safe and feasible.Full English text available from: www.revespcardiol.org/en