Transcatheter aortic valve implantation: our experience and perspective
Sažetak
Purpose: Trans-catheter aortic valve implantation is today an alternative therapy for symptomatic severe aortic valve stenosis in high-risk patients with co-morbidity. Material and methods: From March 2011 to September 2012, fourteen patients with symptomatic severe aortic valve stenosis reach criteria and underwent trans-catheter aortic valve implantation's procedures in Clinical center of Montenegro. All patients received percutaneous aortic valve prosthesis (CoreValve – Medtronic, Minneapolis USA). In thirteen patients femoral approach were performed and one case we used subclavian approach.
Results: Patients mean age was 72.7±2.72 years (seven males and seven females) mean left ventricular ejection fraction was 51.25±6.34 mean peak gradient across aortic valve 94.7±26.61 mmHg) and aortic valve area 0.66±0.19. Society of Thoracic Surgeons score was 9.4±3.18. The follow-up examinations were performed six months after valve implantation.
At the control examinations there were no deaths. Three serious complications has been recorded. One patient received stroke with left side hemiparesis, Two patients had AV block, which was solved by installing pace maker. At control examination mean left ventricular ejection fraction was 54.44±6.8 (NS) mean peak gradient across aortic valve was 20.28±13.13 mmHg. (p>0.01)
Conclusions: Surgical aortic valve replacement remains the standard treatment of patients with aortic stenosis. Trans-catheter aortic valve implantation should be reserved for patients who have unacceptable surgical risks, and who have decreased life expectancy. Main procedure limitations today is stiff and wide delivery equipment and imperfections of attendant imaging software.
Reference
Ambler G, Omar RZ, Royston P, Kinsman R, Keogh BE, Taylor KM Generic, simple risk stratification model for heart valve surgery. Circulation 2005;112:224-231
Davies SW, Gershlick AH, Balcon R. Progression of valvular aortic stenosis: a long-term retrospective study. Eur Heart J 1991;12:10-4.
Kelly TA, Rothbart RM, Cooper CM, Kaiser DL, Smucker ML, Gibson RS. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol 1988;61:123-30.
Passik CS, Ackermann DM, Pluth JR, Edwards WD Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases..Mayo Clin Proc. 1987 Feb;62(2):119-23.
Fairbairn TA, Meads DM, Mather AN, Motwani M, Pavitt S, Plein S, Blackman DJ, Greenwood JP. Serial change in health-related quality of life over 1 year after transcatheter aortic valve implantation: predictors of health outcomes.J Am Coll Cardiol. 2012;59(19):1672-80.
Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002;106:3006-8.
Latsios G, Gerckens U, Grube E, Transaortic transcatheter aortic valve implantation: A novel approach for the truly "no-access option" patients Cathet.and Cardiovas. Interv. 2010;75(7): 1129-1136,
.Schoenhagen P, Kapadia SR, Halliburton SS, Svensson LG, Tuzcu EM ,Computed tomography evaluation for transcatheter aortic valve implantation (TAVI): imaging of the aortic root and iliac arteries. J Cardiovasc Comput Tomogr. 2011;5(5):293-300
Gerald S. Bloomfield, Linda D. Gillam, Rebecca T. Hahn, et all A Practical Guide to Multimodality Imaging of Transcatheter Aortic Valve Replacement Cardiovascular Imaginag 2012;5:441-5
Vahanian A, Himbert D, Brochet E, Depoix JP, Iung B, Nataf P Transcatheter aortic valve implantation: our vision of the future. Arch Cardiovasc Dis 2012;105(3):181-6
Smith CR, Leon MB, Mack MJ, Miller C, Moses JW, Svensson LG, Tuzcu EM et all.Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients N Engl J Med 2011;364(23):2187-2198
Bagur R, Rodés-Cabau J, Gurvitch R, Dumont E, Velianou JL, Manazzoni J, Toggweiler S, atall Need for permanent pacemaker as a complication of transcatheter aortic valve implantation and surgical aortic valve replacement in elderly patients with severe aortic stenosis and similar baseline electrocardiographic findings. JACC Cardiovasc Interv. 2012;5(5):540-51.
Stortecky S, Windecker S, Pilgrim T, Heg D, Buellesfeld L, Khattab AA, Huber C, Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes.. Euro Intervention. 2012;8(1):62-70
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