Transcatheter Aortic Valve Replacement With the St. Jude Medical Portico Valve

• Published in: Journal of the American College of Cardiology Vol. 60; no. 7; pp. 581 - 586
• Main Authors: Willson, Alexander B., MBBS, MPH, Rodès-Cabau, Josep, MD, Wood, David A., MD, Leipsic, Jonathon, MD, Cheung, Anson, MD, Toggweiler, Stefan, MD, Binder, Ronald K., MD, Freeman, Melanie, MBBS, DeLarochellière, Robert, MD, Moss, Robert, MBBS, Nombela-Franco, Luis, MD, Dumont, Eric, MD, Szummer, Karolina, MD, Fontana, Gregory P., MD, Makkar, Raj, MD, Webb, John G., MD
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 14-08-2012; Elsevier Limited
• Subjects: aortic stenosis; Cardiology; Cardiovascular; Catheters; Chronic obstructive pulmonary disease; Heart attacks; Internal Medicine; Medical imaging; Mortality; NMR; Nuclear magnetic resonance; Patients; Retention; Stroke; Tomography; transcatheter aortic valve implantation; transcatheter aortic valve replacement; Minnesota; Quebec City Quebec Canada; transcatheter aortic valve implantation; THV; TTE; LVEF; transcatheter heart valve; transthoracic echocardiography; MDCT; left ventricular ejection fraction; TAVR; aortic stenosis; TEE; multidetector computed tomography; transcatheter aortic valve replacement; transesophageal echocardiography
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.02.045

Objectives The purpose of this study was to demonstrate the feasibility and procedural outcomes with a new self-expanding and repositionable transcatheter heart valve. Background Transcatheter aortic valve replacement is a viable option for selected patients with severe symptomatic aortic stenosis. However, suboptimal prosthesis positioning may contribute to paravalvular regurgitation, atrioventricular conduction block, and mitral or coronary compromise. Methods The repositionable Portico valve (St. Jude Medical, Minneapolis, Minnesota) was implanted in 10 patients with severe aortic stenosis utilizing percutaneous femoral arterial access. Patients underwent transthoracic and transesophageal echocardiography and multidetector computed tomography before and after valve implantation. Clinical and echocardiographic follow-up was obtained at 30 days. Results Device implantation was successful in all patients. Prosthesis recapture and repositioning was performed in 4 patients. Intermittent prosthetic leaflet dysfunction in 1 patient required implantation of a second transcatheter valve. There was 1 minor stroke. At 30-day follow-up, echocardiographic mean transaortic gradient was reduced from 44.9 ± 16.7 mm Hg to 10.9 ± 3.8 mm Hg (p < 0.001), and valve area increased from 0.6 ± 0.1 cm2 to 1.3 ± 0.2 cm2 (p < 0.001). Paravalvular regurgitation was mild or less in 9 patients (90%) and moderate in 1 patient (10%). There were no major strokes, major vascular complications, major bleeds, or deaths. No patient required pacemaker implantation. All patients were in New York Heart Association functional class II or less. Conclusions Transcatheter aortic valve replacement with the repositionable Portico transcatheter heart valve is feasible, with good short-term clinical and hemodynamic outcomes.