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Treatment of Calcific Aortic Stenosis With the Percutaneous Heart Valve

Mid-Term Follow-Up From the Initial Feasibility Studies: The French Experience

Alain Cribier, MD, FACC^_*,_*, Helene Eltchaninoff, MD^_*, Christophe Tron, MD^_*, Fabrice Bauer, MD^_*, Carla Agatiello, MD^_*, Deborah Nercolini, MD^_*, Sydney Tapiero, MD^_*, Pierre-Yves Litzler, MD, Jean-Paul Bessou, MD and Vasilis Babaliaros, MD^_*

^_* Department of Cardiology, Charles Nicolle Hospital, Rouen, France
Department of Cardiac Surgery, Charles Nicolle Hospital, Rouen, France

View larger version (88K): [in a new window]   Figure 1 (A) Top view of the percutaneous heart valve in the closed position showing the three pericardial leaflets sutured to the stainless-steel stent. (B) Side view of the percutaneous heart valve crimped over a 3-cm x 22-mm balloon catheter. (C) Side view of the percutaneous heart valve after being expanded by the delivery balloon.

View larger version (42K): [in a new window]   Figure 2 Electrocardiogram and aortic pressure curve depicting the effect of rapid stimulation (arrows) of the right ventricle (200 to 220 stimulations/min).

View larger version (121K): [in a new window]   Figure 3 (A) Swan-Ganz (SG) catheter is used to direct a guidewire (GW) across the native aortic valve in the antegrade approach. (B) Guidewire loop in the left ventricle is tracked by the percutaneous heart valve from the right femoral vein (antegrade approach). Sones catheter (SC) from the left femoral artery is used to help position the percutaneous heart valve. Native aortic valve calcifications (arrows) in the anteroposterior projection transect the mid-line of the length of the stent valve. (C) Deployment of the percutaneous heart valve using the antegrade approach. (D) Valve deployment via the retrograde method. (E) Supra-aortic angiogram showing no aortic regurgitation and the subcoronary position of the percutaneous heart valve (arrow: filling of the left coronary artery). (F) Cranial view of the percutaneous heart valve showing symmetrical and complete expansion of the stent frame. MS = Mullins sheath; PL = pacing lead.

View larger version (27K): [in a new window]   Figure 4 Schematic representation of patient enrollment and procedural success (*Patient #16 was implanted successfully by the antegrade approach after initial retrograde failure). PHV = percutaneous heart valve.

View larger version (26K): [in a new window]   Figure 5 (A) Improvements in aortic valve area in patients 24 h, 1, 3, 6, 12, and 24 months after successful implantation. (B) Decrease in mean aortic gradient in patients 24 h, 1, 3, 6, 12, and 24 months after successful implantation.

View larger version (28K): [in a new window]   Figure 6 (A) Improvement in ejection fraction one week after successful implantation (n = 22). (B) Improvement in ejection fraction comparing baseline values with values one week after successful implantation in patients with left ventricular function <50% (n = 15).