The Italian Society of Invasive Cardiology Registry on Percutaneous Aortic Valve

Aortic valve stenosis is the most common degenerative valve disease in the elderly, the prevalence is about 1-2% in the age group> 65 years and 4% in patients aged> 85. The natural history is characterized by a poor prognosis with a survival rate of 62% at 1 year, 32% at 5 years and 18% at 10 years from symptom onset. Predictors of death were age> of 75 years, poor left ventricular ejection fraction, congestive heart failure, chronic obstructive pulmonary disease, severe mitral regurgitation and pulmonary hypertension.

The gold standard therapy, with improved survival, for severe aortic stenosis is the surgical aortic valve replacement with mechanical or biological prosthesis. Cardiac surgery is therapy of choice for patients with severe aortic valve stenosis with left ventricular dysfunction or when symptomatic for lipothymia or syncope, angina pectoris, heart failure.

Criteria for high surgical risk are: left ventricular failure, coronary artery disease, previous cardiac surgery for coronary artery bypass , chronic obstructive pulmonary disease, and/or advanced age and comorbidity , which can be a contraindication to intervention. Frequently cardiac surgery is not performed in elderly patients for the high surgery risk. In the Euro Heart Survey up to 33% of patients with single valve disease, New York Heart Association class III or IV, were not operated for concomitant disease or reduced life expectancy.

The need to provide a therapeutic option for patients considered at high surgery risk, has stimulated the development of prosthetic valve implantable with a percutaneous transcatheter techniques. The percutaneous treatment of valvular aortic stenosis has potential advantages in terms of reduction of hospitalization of elderly patients with high risk of peri-operative mortality and morbidity, as well as avoiding treatment with oral anticoagulants. The experience up to now is very positive, with immediate favorable results in terms of hemodynamic and clinical improvement. Since the procedure is at initial stage of clinical application, it becomes necessary a uniform and standardized data collection to assess the effectiveness of the procedure, the incidence of acute and late complications, and the performance of the biological valve prosthesis.

The investigators propose the establishment of an observational registry of percutaneous aortic valve replacement performed in the Italian Interventional Cardiology Laboratory.