scholarly journals Percutaneous implantation of self-expandable aortic valve in high risk patients with severe aortic stenosis: The first experiences in Serbia

2016 ◽  
Vol 73 (2) ◽  
pp. 192-197 ◽  
Author(s):  
Milan Nedeljkovic ◽  
Branko Beleslin ◽  
Milorad Tesic ◽  
Vladan Vukcevic ◽  
Goran Stankovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Vascular Complication ◽  
Functional Improvement ◽  
Heart Team ◽  
Initial Experience ◽  
Surgical Risk ◽  
Number Of Patients ◽  
High Surgical Risk

Background/Aim. Aortic stenosis (AS) is the most common valvular heart disease in elderly people, with rather poor prognosis in symptomatic patients. Surgical valve replacement is the therapy of choice, but a significant number of patients cannot undergo surgical procedure. We presented initial experience of transcatheter aortic valve implantation (TAVI) performed in Catheterization Laboratory of the Clinic for Cardiology, Clinical Center of Serbia. Methods. The procedures were performed in 5 patients (mean age 76 ? 6 years, 2 males, 3 female) with severe and symptomatic AS with contraindication to surgery or high surgical risk. The decision to perform TAVI was made by the heart team. Pre-procedure screening included detailed clinical and echocardiographic evaluation, coronary angiography and computed tomography scan. In all the patients we implanted a self-expandable aortic valve (Core Valve, Medtronic, USA). Six months follow-up was available for all the patients. Results. All interventions were successfully performed without significant periprocedural complications. Immediate hemodynamic improvement was obtained in all the patients (peak gradient 94.2 ? 27.6 to 17.6 ? 5.2 mmHg, p < 0.001, mean pressure gradient 52.8 ? 14.5 to 8.0 ? 2.1 mmHg, p < 0.001). None of the patients developed heart block, stroke, vascular complication or significant aortic regurgitation. After 6 months, the survival was 100% with New York Heart Association (NYHA) functional improvement in all the patients. Conclusion. This successful initial experience provides a solid basis to treat larger number of patients with symptomatic AS and high surgical risk who are left untreated.

scholarly journals Experience with Percutaneous Aortic Valve Implantation in Patients with Severe Aortic Stenosis at High Surgical Risk in a Rural Community

2019 ◽  
Vol 87 (4) ◽  
pp. 310-312
Author(s):  
Federico Blanco ◽  
Rodrigo Blanco ◽  
Mauricio Bonet ◽  
Gustavo Iralde ◽  
Mariano Campeni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Rural Community ◽  
Severe Aortic Stenosis ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals P1456 Pacemaker and percutaneous aortic valve endocarditis - a complex decision

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Cardoso ◽  
G Dias ◽  
P Von Hafe ◽  
B Faria ◽  
M Fernandes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Enterococcus Faecalis ◽  
Antibiotic Treatment ◽  
Severe Aortic Stenosis ◽  
Blood Cultures ◽  
Chronic Obstructive ◽  
Heart Team ◽  
Complex Situation ◽  
Surgical Risk ◽  
High Surgical Risk

Abstract CASE REPORT We describe the case of a 64-year-old man who was referred because of a fever. He had history of hypertension, dyslipidemia, atrial fibrillation, chronic obstructive pulmonary disease and a right lung pneumectomy due to epidermoid lung cancer diagnosed twenty-five years ago. He implanted dual-chamber definite pacemaker ten years ago and had a transcatheter aortic valve implantation (TAVI) in the previous year due to severe aortic stenosis and a high surgical risk. He was hospitalized 2 months ago because of a respiratory infection. Blood cultures were positive for an Enterococcus faecalis. A transthoracic echocardiogram was performed and had no evidence of vegetations. After one month, he had recurrence of fever and was again admitted. On physical examination he was hemodynamically stable, with signs of peripheral congestion and no heart murmur on cardiac auscultation. Blood cultures were again positive for Enterococcus faecalis. The transesophageal echocardiogram (TEE) showed a biologic aortic valve with thickened leaflets and small nodular structures suggestive of vegetations. There was a small periprosthetic leak and no obstruction or suspected perivalvular abscesses. There was also a small vegetation with 0,45*0,3 cm in the auricular pacemaker lead. A thoraco-abdomino-pelvic computed tomography scan showed no embolic complications. A diagnosis of pacemaker and TAVI endocarditis was made. The patient started directed antibiotic therapy (ceftriaxone and ampicillin). The case was discussed in Heart Team and because of high surgical risk, medical treatment was decided. The patient completed antibiotic treatment with negative blood cultures and apyrexia. A repeated TEE showed persistence of vegetations, without development of local complications. It was decided to discharge the patient under palliative suppressive antibiotic treatment with levofloxacin after discussion with the infectious disease doctor. In a follow-up evaluation, he remained clinically stable, without recurrence of fever. DISCUSSION As TAVI procedures are performed more frequently, a higher number of late complications are expected. Prosthetic valve endocarditis after TAVI is a complex situation, whose treatment strategy is not well-defined, particularly because these patients are usually of high surgical risk. This case describes a complex clinical picture and highlights the difficulty in decision-making in these situations. Also, it pretends to reinforce the need to discuss in a Heart Team the best treatment options.

scholarly journals First experience of using NVT Allegra system for transcatheter implantation of aortic valve and prospects for routine interventions on aortic valve in Ukraine

2020 ◽  
Vol 27 (2) ◽  
pp. 57-64
Author(s):  
G. B. Mankovsky ◽  
Ye. Yu. Marushko ◽  
S. O. Kuzmenko ◽  
G. I. Yemets ◽  
I. M. Yemets
Keyword(s):  
Blood Flow ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Valve Prosthesis ◽  
Surgical Risk ◽  
High Surgical Risk ◽  
Aortic Valve Prosthesis ◽  
Transcatheter Implantation ◽  
Flow Gradients

The aim – to present the first experience in Ukraine of using the NVT Allegra device for the procedure of transcatheter implantation of the aortic valve prosthesis to patients with high surgical risk with severe aortic stenosis. Materials and methods. The presented clinical cases included two patients of age 90 and 80 years with severe aortic stenosis, mean transaortic blood flow gradients of 32 and 76 mm Hg and aortic valve areas of 0.4 and 0.6 cm2, respectively. Both patients were recognized as high surgical risk patients. Results and discussion. Both patients underwent transcatheter implantation of the aortic valve prosthesis through transfemoral access. After implantation, the average gradients of the transaortic blood flow were 13 and 8 mm Hg respectively. Residual paravalvular insufficiency was mild in both cases. Second patient was implanted permanent pacemaker due to persistent complete AV block. Conclusions. The NVT Allegra system for transcatheter implantation of the aortic valve prosthesis is a third generation device that enables successful and safe intervention of the aortic valve.

scholarly journals The choosing of method for treatment of severe aortic stenosis in senile patients

2019 ◽  
pp. 41-52
Author(s):  
Evgeniy Kryukov ◽  
Dmitry Kranin ◽  
Alexey Fedorov ◽  
Aleksei Gaidukov ◽  
Dmitry Nazarov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Risk ◽  
Fourth Group ◽  
The Third ◽  
Aortic Valvuloplasty ◽  
High Surgical Risk

Introduction.Aortic valve stenosis is the most common valvular pathology in cardiac surgery patients: aortic valve stenosis correction surgery accounts for 10 to 22% of open-heart surgery. 30% of senile patients with severe aortic stenosis due to severe comorbidity and high operational mortality are denied prosthetics of the aortic valve under cardiopulmonary bypass. With the appearance of endovascular correction - minimally invasive surgical treatment methodsthe problem of choosing a method of correction of severe aortic stenosis in these patients arose. Objectives. To select a method for surgical correction of severe aortic valve stenosis in senile patients, determine the place of intra-aortic valvuloplasty in treatment, and create an algorithm for treatment of senilepatients. Patients and methods. The study included 122 patients >75 years old with severe aortic stenosis, confirmed by echocardiography (aortic valve area<1 cm2, mean pressure gradient (aortic valve) >40 mm Hg, peak velocity (aortic valve) >4.0 m/s), undergoing treatment at Cardiovascular Surgery Dept of the BurdenkoMain Military Clinical Hospital in 2010 – 2017. Due to the high surgical risk, patients of the first group (n = 89) underwent only conservative drug therapy, patients of the second group (n = 12) underwent prosthetic aortic valve replacement under cardiopulmonary bypass, and patients of the third group (n = 8) underwent balloon aortic valvuloplasty valve, after which 7 of them entered the fourth group, patients of the fourth group (n = 20) performed Transcatheter Aortic Valve Implantation . Results. In the maximum follow-up three-year period, the mortality rate in patients of the first group was 49.5%, the severity of heart failure in most of the surviving patients was at III-IV Class(NYHA); mortality in the second group of observation was 16.6%, there was a decrease in the severity of heart failure - the transition of most patients from III - IV to II Class (NYHA); in 7 out of 8 patients of the third group, after performing aortic valve valvuloplasty, hemodynamic stabilization was noted - in 5 patients there was a decrease in the manifestations of heart failure to III Class and in 2 patients - to II Class (NYHA), all of them entered the fourth group, in which, after performing TIAK the mortality was not notedduring the three-year observation of. Conclusions. In senile patients, surgical treatment of severe aortic stenosis is the method of choice and can significantly increase the one-year and three-year survival. In the group of senile patients with high surgical risk, endovascular correction of aortic stenosis is preferred. Balloon valvuloplasty of the aortic valve can be considered as a stage in the surgical treatment of severe aortic stenosis in patients with extremely high surgical risk. The next step in this group of patients should be performed transcatheter implantation of the aortic valve. The developed algorithm of a differentiated approach to the choice of a treatment method for severe aortic stenosis in senile patients allows a 32% increase (p <0.05) in the number of cases of radical surgical care for senile patients previously considered unpromising due to the impossibility of surgical treatment.

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