scholarly journals Treatment of high-risk patients with severe aortic stenosis by the use of transcatheter aortic valve implantation

2018 ◽  
Vol 9 (1) ◽  
pp. 84-89
Author(s):  
Alexey V. Sizov ◽  
Alexey S. Sergeev ◽  
Evgeny A. Shloydo ◽  
Valentin K. Suchov ◽  
Victoria V. Zvereva
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Age Groups ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Aortic stenosis is the most common disease from the group of acquired heart diseases. The frequency and degree of damage of the aortic valve increases with age. The prevalence of this disease increases due to the general extension in life expectancy of the population. Aortic valve stenosis caused by calcification is the pathology with progressive course characterized by a poor prognosis at the stage of expanded symptoms. Five-year survival of patients with developed clinical picture of aortic stenosis without surgery, according to some estimates, is reduced to 15%, which is the worst figure, even in comparison with most potentially incurable cancer. In the treatment of aortic stenosis aortic valve replacement is the “gold standard” and gives positive results in all age groups of patients. Only one third of patients are sent for aortic valve replacement owing to high risk caused by the age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. Aortic valve replacement in patients of the older age groups with concomitant diseases is associated with high level of hospital mortality. One of the attempts to reduce the frequency of complications and mortality in this group of patients is the implementation of a less traumatic surgery – transcatheter aortic valve implantation. At present our clinic has successfully performed more than 70 operations of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is a good alternative to standard aortic valve replacement in patients with high risk of open-heart surgery.

scholarly journals Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L1-L5
Author(s):  
Igor Belluschi ◽  
Nicola Buzzatti ◽  
Alessandro Castiglioni ◽  
Michele De Bonis ◽  
Matteo Montorfano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
First Choice ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.

Abstract 2307: Contemporary Perioperative Results of Isolated Aortic Valve Replacement for Aortic Stenosis: Implications for Transcatheter Aortic Valve Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
S C Malaisrie ◽  
Patrick M McCarthy ◽  
Edwin C McGee ◽  
Richard Lee ◽  
Vera Rigolin ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (AVI) is compelling for some high-risk patients with aortic stenosis (AS). However, comparison of procedure outcomes with older surgical series may overestimate operative risk. We therefore analyzed our contemporary series of isolated aortic valve replacement (AVR) for AS. From April 2004 to January 2008, 642 patients underwent AVR with or without concomitant cardiac procedures. Of these patients, 175 patients had an isolated AVR, and 140 patients underwent isolated AVR for AS. The characteristics were age 68, male gender 56%, ejection fraction 57%. Sixty-four percent had a minimally-invasive AVR and 18% were reoperations. Twenty percent were 80 years old or greater, 35% were in NYHA functional class III-IV, and 4% had an estimated operative mortality of 10% or greater using the Society of Thoracic Surgery (STS) risk calculator. Thirty-day mortality was 0%, but there was one in-hospital death (0.7%) from complications of an esophageal perforation. Reoperation for bleeding occurred in 5.7%, cerebrovascular accident (CVA) in 0%, acute renal failure (ARF) in 2.9%, myocardial infarction (MI) in 0%. Bioprosthetic valves were used in 98.6% and mechanical in 1.4%. Mean gradient decreased from 48 mmHg to10 mmHg. Actuarial survival was 97% and 90% at 1 and 3 years. Patients >80 years (n=28) were more likely to have an increased length of hospital stay (9.8 versus 6.3 days, p=0.01) and less likely to be discharged to home (48% versus 86%, p<0.01) as compared to patients <80 years. Today, AVR for AS can be performed in many high-risk patients with low operative mortality and morbidity, although patients over 80 years are at greater risk of prolonged recovery. Transcatheter AVI should be compared to this high threshold.

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