Transcheter aortic valve implantation as a method of treatment of chronic heart failure in elderly and old patients: Literature review (part 1)

2022 ◽  
pp. 901-909
Author(s):  
К. Л. Козлов ◽  
А.Н. Богомолов ◽  
Е.И. Сенькина ◽  
Н.Г. Лукьянов ◽  
Л.В. Башкатова ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Age Groups ◽  
Interventional Cardiology ◽  
Old Patients ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Стеноз аортального клапана (АК) - самое частое приобретенное клапанное заболевание с растущей распространенностью из-за старения населения, требующее хирургического или эндоваскулярного вмешательства. Транскатетерная имплантация АК (Transcatheter Aortic Valve Implantation, TAVI) представляет собой настоящую революцию в области интервенционной кардиологии для лечения пациентов старческого возраста или из группы высокого риска с тяжелым симптомным стенозом АК. TAVI позволяет выполнять коррекцию аортального порока наиболее тяжелой группе больных ХСН с выраженной коморбидностью, которым противопоказано выполнение открытой операции по замене АК, для прерывания порочного круга в прогрессировании ХСН, стимуляции обратного ремоделирования миокарда, облегчения симптомов, улучшения качества жизни и прогноза больных, а также в качестве «моста» к трансплантации сердца. Благодаря разработке устройств нового поколения, TAVI превратилась из сложной и опасной процедуры в эффективную и безопасную методику. Наибольший научный интерес в настоящее время представляет изучение долговечности клапана и возможности расширения показаний к выполнению TAVI у категорий пациентов с низким хирургическим риском, а также более молодого возраста. Aortic valve (AV) stenosis is the most common acquired valvular disease with an increasing prevalence due to an aging population, requiring surgical or endovascular intervention. Transcatheter Aortic Valve Implantation (TAVI) represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk patients with severe symptomatic AV stenosis. TAVI allows for the correction of aortic defect in the most severe group of patients with chronic heart failure (CHF) with severe comorbidity, who are contraindicated for open surgery to replace AV, in order to interrupt the vicious circle in the progression of CHF, stimulate reverse myocardial remodeling, alleviate symptoms, improve the quality of life, and prognosis of patients, and also as a «bridge» to heart transplantation. With the development of next-generation devices, TAVI has evolved from a complex and dangerous procedure to an effective and safe technique. Currently, the greatest scientific interest is the study of valve durability and the possibility of expanding the indications for performing TAVI in categories of patients with low surgical risk, as well as in younger age groups.

scholarly journals Decentralisation of Transcatheter Aortic Valve Implantation- a review of outcomes and experiences in developing a service in Remote Australia

2021 ◽  
Author(s):  
Frazer Kirk ◽  
Lim Eng ◽  
Sumit Yadav
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Minimally Invasive ◽  
Transcatheter Aortic Valve Implantation ◽  
Interventional Cardiology ◽  
Tertiary Hospital ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Regional Australia

The introduction of Transcatheter Aortic Valve Implantation (TAVI) has transformed interventional cardiology and minimally invasive cardiac surgery. TAVI is a relatively new technique that is rapidly expanding in its indications and technology as well as places of practice. De-centralisation of this previous supra-specialised procedure can be done safely and efficaciously, to improve the health inequalities across regional and remote Australia. The purpose of this study is to detail the introduction of the TAVI program at a geographically isolated tertiary hospital in regional Australia. Illustrating the safe introduction of TAVI in this location may guide other isolated hospitals on the introduction of the service.

scholarly journals The Prognosis of Baseline Mitral Regurgitation in Patients with Transcatheter Aortic Valve Implantation

2021 ◽  
Vol 10 (17) ◽  
pp. 3974
Author(s):  
Juqian Zhang ◽  
Arnaud Bisson ◽  
Jad Boumhidi ◽  
Julien Herbert ◽  
Christophe Saint Etienne ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Transcatheter Aortic Valve Implantation ◽  
Cardiovascular Mortality ◽  
Prognostic Impact ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Mitral regurgitation (MR) is the most common valvular lesion in transcatheter aortic valve implantation (TAVI) recipients. This study aims to assess the long-term prognostic impact of baseline MR in TAVI patients. Methods: Adult patients who underwent TAVI were identified in the French National Hospital Discharge Database. All-cause and cardiovascular mortality, stroke, and rehospitalization with heart failure (HF) were compared in TAVI patients with and without baseline MR and tricuspid regurgitation (TR), respectively; the associations of MR and TR with the outcomes were assessed by Cox regression. Results: Baseline MR was identified in 8240 TAVI patients. Patients with baseline MR have higher yearly incidence of all-cause mortality (HR: 1.192, 95% confidence interval CI: 1.125–1.263), cardiovascular mortality (HR: 1.313, 95%CI: 1.210–1.425), and rehospitalization for heart failure (HF) (HR: 1.411, 95%CI: 1.340–1.486) compared to those without, except for stroke rate (HR: 0.988, 95%CI: 0.868–1.124). Neither baseline MR nor TR was an independent risk predictor for all-cause mortality or cardiovascular mortality in TAVI patients. Baseline MR was independently associated with rehospitalization for HF in TAVI patients. Conclusions: Baseline MR and TR were associated with increased all-cause and cardiovascular mortality post-TAVI, however, neither of them was independent predictor for all-cause or cardiovascular mortality.

Predictors and outcomes of heart failure after transcatheter aortic valve implantation using a self-expanding prosthesis

2020 ◽  
Vol 73 (5) ◽  
pp. 383-392 ◽  
Author(s):  
Adrián Cid-Menéndez ◽  
Diego López-Otero ◽  
Rocío González-Ferreiro ◽  
Diego Iglesias-Álvarez ◽  
Leyre Álvarez-Rodríguez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis

2020 ◽  
Vol 41 (20) ◽  
pp. 1903-1914 ◽  
Author(s):  
Miriam Puls ◽  
Bo Eric Beuthner ◽  
Rodi Topci ◽  
Anja Vogelgesang ◽  
Annalen Bleckmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Lv Function ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims  Myocardial fibrosis (MF) might represent a key player in pathophysiology of heart failure in aortic stenosis (AS). We aimed to assess its impact on left ventricular (LV) remodelling, recovery, and mortality after transcatheter aortic valve implantation (TAVI) in different AS subtypes. Methods and results  One hundred patients with severe AS were prospectively characterized clinically and echocardiographically at baseline (BL), 6 months, 1 year, and 2 years following TAVI. Left ventricular biopsies were harvested after valve deployment. Myocardial fibrosis was assessed after Masson’s trichrome staining, and fibrotic area was calculated as percentage of total tissue area. Patients were stratified according to MF above (MF+) or below (MF−) median percentage MF (≥11% or <11%). Myocardial fibrosis burden differed significantly between AS subtypes, with highest levels in low ejection fraction (EF), low-gradient AS and lowest levels in normal EF, high-gradient AS (29.5 ± 26.4% vs. 13.5 ± 16.1%, P = 0.003). In the entire cohort, MF+ was significantly associated with poorer LV function, higher extent of pathological LV remodelling, and more pronounced clinical heart failure at BL. After TAVI, MF+ was associated with a delay in normalization of LV geometry and function but not per se with absence of reverse remodelling and clinical improvement. However, 22 patients died during follow-up (mean, 11 months), and 14 deaths were classified as cardiovascular (CV) (n = 9 arrhythmia-associated). Importantly, 13 of 14 CV deaths occurred in MF+ patients (CV mortality 26.5% in MF+ vs. 2% in MF− patients, P = 0.0003). Multivariate analysis identified MF+ as independent predictor of CV mortality [hazard ratio (HR) 27.4 (2.0–369), P = 0.01]. Conclusion  Histological MF is associated with AS-related pathological LV remodelling and independently predicts CV mortality after TAVI.

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