Ibrahim Akin, Stephan Kische, Tim C. Rehders, Christoph A. Nienaber, Mathias Rauchhaus, Hüseyin Ince, Henrik Schneider, Andreas Liebold Santa Rosa, CA). Percutaneous aortic valve the mean aortic valve area increased from 0.60 implantation represents a unique challenge for ±0.11 cm2 to 1.70 ±0.10 cm2 (p < 0.001). Importantly, anaesthesiologists. As with other invasive this improvement in aortic valve area was procedures, a careful preoperative assessment, maintained up to 24 months follow-up [13]. After appropriate intraoperative monitoring and imaging, these first trials, the Cribier-Edwards prosthesis and meticulous management of haemodynamics, and the Edwards SAPIEN prosthesis have been used in early treatment of expected side effects and numerous studies. Overall, acute procedural success complications are of utmost importance. An is achieved in 75-100% of the procedures, and unexpected decrease or increase in systemic 30-day mortality ranges between 8% and 50% in the vascular resistance resulting in decreased coronary published studies. Using the transapical technique perfusion pressure or acute heart failure by elevated and the SAPIEN valve, Walther has reported the left ventricular end-diastolic pressure should be initial multicentre results of 59 consecutive patients, avoided by maintaining a normotensive blood which is the largest feasibility study published thus pressure and heart rate between 60 bpm and 100 far. Procedural success using the transapical bpm. The choice of anaesthetic technique, either technique was achieved in 53 patients. Thirty-day local anaesthesia with mild sedation promoting mortality was 13.6% and none of these were spontaneous respiration, deep IV sedation with thought to be valve related as there was good valve insertion of a laryngeal mask or general function at autopsy [14]. anaesthesia, varies among centres and is probably not associated with a significant difference in CoreValve ReValving outcome. Post valvuloplasty and implantation, done Since the first implantation of the CoreValve under rapid right ventricular pacing to reduce left prosthesis in a patient in 2005 [15], a large number ventricular ejection and cardiac motion, may require of patients have been treated with this device to some additional inotropic support. Tracheal date. The feasibility and safety of this valve was extubation can usually be performed at the end of studied in a prospective, multicentre trial. A total of the procedure. Close postoperative monitoring is 25 symptomatic patients with an aortic valve area necessary, and admission to an intensive care unit < 1 cm2 were enrolled in the study. The device was is required. However, at present a retrograde successfully implanted using the retrograde approach through the femoral artery is used. During technique in 22 of 25 patients. Procedural success the procedure, balloon valvuloplasty is first and aortic mean pressure gradients were markedly performed to facilitate passage of the native aortic improved immediately following implantations, with valve. During rapid right ventricular pacing, the pre-procedure gradients of 44.24 ±10.79 mmHg to prosthesis is positioned and deployed under 12.38 ±3.03 mmHg post-procedure, and were about fluoroscopy and echocardiographic guidance. the same at 30-day follow-up (11.82 ±3.42 mmHg). Alternatively, in patients with difficult vascular NYHA class improved by 1 to 2 grades in all patients. access because of extensive calcifications or Major adverse cardiac events (MACE; defined as tortuosity of the femoral artery or aorta, death from any cause, major arrhythmia, myocardial a transapical approach can be used. After a partial infarction, cardiac tamponade, stroke, urgent or thoracotomy, direct puncture of the apical portion emergent conversion to surgery or balloon of the left ventricular free wall is performed to gain valvuloplasty, emergent percutaneous coronary catheter access to the left ventricle and aortic valve. intervention, cardiogenic shock, endocarditis, or The prosthesis is subsequently positioned and aortic dissection) occurred in 8 of the 25 patients deployed, similar to the antegrade approach. while in the hospital [16]. Recently, Grube et al. reported the results with the three different Results from the literature generations of the CoreValve ReValving system. In this non-randomised, prospective study, a total of Cribier-Edwards valve 136 patients were included [17]. Ten patients were Cribier et al. performed the first human treated with first generation devices, 24 patients implantation in 2002 [11]. In the Initial Registry of with second generation, and 102 patients with third EndoVascular Implantation of Valves in Europe generation devices. At baseline, mean aortic valve (I-REVIVE) trial, followed by the Registry of area was 0.67 cm2 and mean logistic EuroSCORE Endovascular Critical Aortic Stenosis Treatment was 23.1% in the overall study population. Overall (RECAST) trial, a total of 36 patients (mean [SD] procedural success rate increased significantly with EuroSCORE 12 [2]) were included [12] Twenty-seven the new generation devices from 70.0% and 70.8% patients underwent successful percutaneous aortic to 91.2% for the first, second, and third generation valve implantation (23 antegrade, 4 retrograde). The prostheses, respectively (p = 0.003). Interestingly, 30-day mortality was 22% (6 of 27 patients), and periprocedural mortality decreased using newer 300 Arch Med Sci 3, June / 2010