First-in-man experience of percutaneous aortic valve replacement using self-expanding corevalve prosthesis.

OBJECTIVE: Percutaneous aortic valve replacement is a new emerging method for nonsurgical replacement of aortic valve in patients with severe aortic stenosis. We report the first-in-man case of percutaneous aortic valve replacement with self-expanding Core Valve aortic prosthesis. METHODS AND RESULTS: The procedure was performed on 12 July 2004 on a 62 years patient with severe aortic stenosis (peak systolic gradients across aortic valve being 90 mm Hg), moderately severe aortic regurgitation and preserved left ventricular systolic function. The patient had associated morbidities like renal failure (raised blood urea nitrogen and serum creatinine levels) and end-stage carcinoma of lung. Valve implantation was performed under general anesthesia with extracorporeal support using the retrograde approach. The patient was adequately screened prior to the procedure. The device was implanted successfully with post implantation peak systolic gradient across aortic valve being only 16 mm Hg. However, this patient died after four days due to renal failure and bleeding diathesis leading to multiorgan failure. CONCLUSIONS: Percutaneous implantation of self-expanding CoreValve prosthesis in patients with severe aortic stenosis with or without aortic regurgitation is feasible. Long-term studies will determine its future.

Major adverse cardiac events in patients with moderate to severe renal insufficiency treated with first-generation drug-eluting stents.

No data are available comparing the long-term outcome of sirolimus-eluting stents (SESs) versus paclitaxel-eluting stents (PESs) in patients with moderate to severe renal insufficiency. The incidence of major adverse cardiac events (MACE), including death, myocardial infarction, and target vessel revascularization, during long-term follow-up were studied in patients with a glomerular filtration rate of <60 ml/min/1.73 m(2), as measured by the Modification of Diet in Renal Disease (MDRD) study equation, who also underwent percutaneous coronary intervention with drug-eluting stents. Of 428 patients studied, PESs were placed in 287 patients and SESs in 141 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 47 + or - 19 months of follow-up, MACE had occurred in 49 (17%) of 287 patients in the PES group (mean age 71 + or - 11 years, 55% men) and in 31 (22%) of 141 patients in the SES group (mean age 71 + or - 12 years, 53% men). No significant difference was found in the MACE rate between the PES and SES groups. This persisted even after controlling for stent length, lesion complexity, and other co-morbidities. Also, all-cause mortality was not significantly different between the PES and SES groups (7.1% vs 8.5%, respectively). In conclusion, during long-term follow-up of patients with moderate to severe renal insufficiency, the rates of MACE and all-cause mortality were similar in the PES and SES groups.

Interventional therapy for multiple cardiac defects.

We describe a patient with a rare combination of coronary artery disease and congenital heart disease. The patient underwent successful complex and multivessel coronary angioplasty, balloon pulmonary valvuloplasty by the Inoue balloon and transcatheter closure of an atrial septal defect in a staged manner. It is technically feasible and safe to perform multiple interventions as an alternative to open heart surgery.