Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.

Abstract

OBJECTIVES:

This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery.

BACKGROUND:

Untreated severe aortic stenosis is a progressive disease with a poor prognosis. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy.

METHODS:

We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG).

RESULTS:

A total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p < 0.0001). Individual 30-day and 12-month events included all-cause mortality (8.4% and 24.3%, respectively) and major stroke (2.3% and 4.3%, respectively). Procedural events at 30 days included life-threatening/disabling bleeding (12.7%), major vascular complications (8.2%), and need for permanent pacemaker placement (21.6%). The frequency of moderate or severe paravalvular aortic regurgitation was lower 12 months after self-expanding TAVR (4.2%) than at discharge (10.7%; p = 0.004 for paired analysis).

CONCLUSIONS:

TAVR with a self-expanding bioprosthesis was safe and effective in patients with symptomatic severe aortic stenosis at prohibitive risk for surgical valve replacement. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).

• Authors: Jeffrey J Popma, David H Adams, Michael J Reardon, Steven J Yakubov, Neal S Kleiman, David Heimansohn, James Hermiller Jr, G Chad Hughes, J Kevin Harrison, Joseph Coselli, Jose Diez, Ali Kafi, Theodore Schreiber, Thomas G Gleason, John Conte, Maurice Buchbinder, G Michael Deeb, Blasé Carabello, Patrick W Serruys, Sharla Chenoweth, Jae K Oh, CoreValve United States Clinical Investigators
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 63 Issue 19 Pg. 1972-81 (May 20 2014) ISSN: 1558-3597 [Electronic] United States
• PMID: 24657695 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve Stenosis (diagnosis, surgery)
• Bioprosthesis (standards)
• Cardiac Catheterization (instrumentation, methods)
• Female
• Follow-Up Studies
• Heart Valve Prosthesis (standards)
• Heart Valve Prosthesis Implantation (instrumentation, methods)
• Humans
• Male
• Prospective Studies
• Prosthesis Design (standards)
• Risk Factors
• Severity of Illness Index
• Treatment Outcome