An independent study published online in the journal Circulation confirmed both early and sustained clinical benefits for patients receiving the CoreValve system (Medtronic) for the treatment of aortic valve disease.
The article, “Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis,” discusses the largest CoreValve clinical study to date, with 663 consecutive aortic stenosis patients (mean age of 81 years) treated at 14 Italian centres beginning immediately after device commercialisation in 2007. The article shows that patients receiving CoreValve have high rates of procedural success (98%), low rates of adverse events (2.1%) and substantial improvements of cardiac function.
The Medtronic CoreValve system is a minimally invasive, non-surgical treatment option for patients with requiring aortic valve replacement who are considered at high risk for surgery; CoreValve is delivered via transcatheter aortic valve implantation (TAVI) rather than open-heart surgery.
“The positive results of our TAVI experience are encouraging and demonstrate positive clinical outcomes for a group of patients with few treatment options,” said Corrado Tamburino, Ferrarotto Hospital, Catania, Italy and principal investigator of the study. “Our findings demonstrate that a large majority of patients were treated successfully with CoreValve and experience improvements in heart function. This real-life registry gives further credence to this new therapy approach.”
The Italian Registry data also evaluated the incidence and predictors of early (30 days) and late (30 days to 1 year) mortality after TAVI. The authors concluded that while early mortality was strongly associated with procedural complications, late mortality was associated with co-morbidities (such as a prior stroke, a prior episode of acute pulmonary edema, or chronic kidney disease) and that pacemaker implant was not a factor.
“We welcome the robust findings from the Italian Registry, which substantially enhance the strong body of clinical evidence supporting the sustained clinical benefits of CoreValve in real-life clinical application,” said John Liddicoat, vice president and general manager of the Structural Heart division at Medtronic. “We are committed to supporting clinical evaluation of the CoreValve system to offer patients with severe aortic stenosis the safest and most adequate technique for treating this disease.”
The CoreValve system received CE mark in March 2007 and has been implanted in more than 12,000 patients worldwide in 42 countries outside the United States. In the US the CoreValve system is being evaluated in a US pivotal clinical trial.
Results
In this study, procedural success was 98% and intraprocedural mortality was 0.9%. Cumulative incidences of mortality were 5.4% at 30 days, 12.2% at 6 months, and 15% at one year. Additionally, the study reported low rates of permanent pacemaker implantation (16.6% at 2-weeks and 17.4% at 30 days). There also was substantial and sustained improvement in patients’ health status, with 71.5% of patients in NYHA class III and IV before the implant achieving class I or II after the procedure.
