[HSF] Calcified aortic stenosis

[Hgrmd at aol.com]

Tom,
  I've attended several valve meetings over the last 2 years in which  the 
results of percutaneous and transapical aortic valve insertion  preliminary 
results of feasibility studies have been shared.  Indeed, these  valves are being 
deployed in cases of porcelain aortas, among other  indications.  Primarily, 
they are being used in very elderly patients with  an average Euroscore of 25 
that have been turned down by 2 cardiac  surgeons.  In Leipzig, they go the 
transapical route without use of the  pump.  This has the advantage of not having 
the device traverse the arch on  its way to the valve.  Fred Mohr theorizes 
that significantly decreases the  risk of stroke.  In fact, none of his 60 
something patients have sustained  a stroke thus far.  However, the 30 day 
mortality is 14%, not an  insignificant number.  I believe a lot of that mortality 
was in the 1st few  cases when they were working out the bugs.  They found with 
oversizing the  valve, the incidence of paravalvular leak was nearly 
eliminated.  
  You can downplay the significance of this new technology at your own  
peril.  I think high volume valve centers will need to learn the  procedure.  
However, more importantly, the indications will have to be  controlled so that it 
is not used in patients who would otherwise be good  surgical candidates.
 
Hal
 



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