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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.

Left-ventricular assist devices have already gained an international place in the treatment of end-stage heart failure. It is expected that in future they will be increasingly used as a temporary bridging following the recovery from heart failure and to a lesser extent as a bridge to heart transplantation. Three patients with end-stage heart failure, men aged 68, 57 and 49 years, received a left-ventricular assist device (LVAD) as a bridge to transplantation. The device chosen was a Heartmate Vented Electric System (ThermoCardiosystems; Woburn, Massachusetts, US). In this system a pump is implanted under the diaphragm and connected to the apex of the left ventricle and the pars ascendens aortae. The first two patients reached the time of transplantation and used the LVAD for 367 and 416 days respectively. The third patient died after the pump had been implanted, due to progressive right-ventricle failure. The first patient died shortly after the heart transplantation.