Description of the characteristics of patients with aortic valve stenosis and high surgical risk considered suitable for percutaneous aortic valve replacement (PAVR) and investigation of the effect of this treatment on survival and the occurrence of complications.

Prospective observational single center cohort study.

Patients with aortic valve stenosis and high surgical risk received a special consultation, after which the heart team decided whether they were considered suitable for PAVR or for surgical valve replacement (AVR). Deaths and complications in the 30 day period after PAVR were registered. The study period was September 2005-January 2009. The EuroSCORE system was used to summarise the patient characteristics, survival was determined by using the Kaplan Meier method, and the subjective health status defined following the New York Heart Association (NYHA) classification.

In the study period 166 patients were referred for PAVR of whom 91 (55%) actually underwent PAVR, 16 (10%) underwent surgical valve replacement (AVR), 39 (23%) were rejected for AVR/PAVR and 20 patients (12%) declined surgical treatment. The mean EuroSCORE (SD) for PAVR was 17% (8), for AVR 12% (7) , for patients unsuitable for surgery 19% (12) and for those declining surgery 25% (14). The mortality and risk of stroke 30 days after PAVR were respectively 12 and 13%. Survival at 1 year after PAVR was 73%. This was associated with a significant improvement of the functional class: before PAVR 15% of patients had NYHA class ≤ 2, and afterwards 72%.

PAVR was associated with a substantial risk of mortality and stroke. The subjective health status of patients did improve substantially after PAVR. In the absence of randomised studies, the authors are of the opinion that PAVR should be restricted to patients who are not considered suitable for surgical valve replacement.