Transcatheter aortic valve implantation: Current status and future perspectives (original) (raw)
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Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis
Circulation Journal, 2010
Although surgery is the gold standard for severe aortic stenosis (AS) treatment, it is considered high risk in elderly patients because of high complication rates, which leads to substantial hesitation in submitting such patients to surgery. With the growing need to treat elderly patients with severe AS, percutaneous transcatheter aortic valve implantation (TAVI) was pioneered in 2001, followed by implantation of a self-expanding percutaneous aortic valve in 2005. As of April 2010, these 2 methods of TAVI have been used in more than 15,000 patients throughout the world. The acute success rate of this procedure is now increasing up to 95.4% by the transfemoral approach and 92.7% by the transapical approach with regard to Edwards SAPIEN ® valve implantation. In terms of the Corevalve ReValving ® system, it is reported as 98.2% in an expert's hands. This article reviews the methods of TAVI and the devices, not yet been approved in Japan but are expected to be available in a few years.
Transapical Aortic Valve Implantation in High-Risk Patients With Severe Aortic Valve Stenosis
The Annals of Thoracic Surgery, 2011
Background. Transapical aortic valve implantation (TA-TAVI) represents an alternative in patients with symptomatic severe aortic valve stenosis (SSAVS) who cannot be operated on or have a high surgical risk. The aim of this prospective multicenter observational study was to assess early and 2-year clinical and hemodynamic outcomes after TA-TAVI.
American Heart Journal, 2010
Transcatheter aortic valve implantation (TAVI) is an alternative treatment option for patients with aortic stenosis deemed high risk or unsuitable for aortic valve replacement. The aim of this study was to assess the feasibility of TAVI in elderly patients, the delivery of this technology with a multidisciplinary approach, and the use of traditional surgical scoring systems. One hundred fifty-one consecutive patients (mean age 82.6 +/- 7.3 years) with severe aortic stenosis underwent TAVI with the Edwards Lifesciences (Irvine, CA) Sapien bioprosthesis using the transapical (n = 84; 56%) or transfemoral (n = 67; 44%) approach from August 2007 to September 2009 at King's Health Partners, London, United Kingdom. We analyzed procedural outcome, complications, functional status, and midterm outcome of patients. The multidisciplinary team comprised interventional cardiologists, cardiothoracic surgeons, imaging specialists, cardiac anesthetists, and specialist nurses. Seventy percent of patients were in New York Heart Association class III/IV, and logistic EuroSCORE was 21.6 +/- 11.9. Procedural success was achieved in 98%. Postoperative complications included stroke (6%), complete atrioventricular block (5.3%), renal failure requiring hemofiltration (9.3%), and vascular injury (8.6%). Overall 30-day mortality was 9.9% (n = 15). The logistic EuroSCORE was a predictor of short-term mortality (logistic regression model, P < .05). Thirty-day mortality post-TAVI for patients with logistic EuroSCORE <20, 20 to 40, and >40 was 5.4%, 13.2%, and 22.2%, respectively. Transcatheter aortic valve implantation is a feasible treatment option in this patient group with promising short/medium-term results. Renal failure is the commonest short-term complication, and the incidence of vascular complications remains high. Risk prediction/case selection remains challenging, and a multidisciplinary team approach appears to be helpful in appropriate patient selection.
Revista Brasileira de Cardiologia Invasiva English Version, 2013
Background: Transcatheter aortic valve implantation (TAVI) is a treatment option for patients with aortic valve stenosis (AS) and high or prohibitive surgical risk. We report our experience using the Medtronic CoreValve TM self-expending system. Methods: From 2009 to 2013, 51 consecutive patients with severe symptomatic AS and high or prohibitive surgical risk were submitted to TAVI. Results were analyzed according to the criteria of the Valve Academic Research Consortium (VARC) -2. Results: Mean age was 82 ± 6 years, 49% were female, 19% were diabetic, 21% had renal failure and the logistic EuroScore was 17.4 ± 11.4%. The success rate of the device was 84.3%. All of the patients had a significant decrease of transaortic gradients, which was maintained over time. Hospitalization time was 6 days (interquartile range: 5-8.8). In-hospital mortality at 30 days as 7.8% and 9.8%, respectively. Permanent pacemaker implantation was required in 32.6% of the cases; ischemic stroke was observed in 3.9% and major vascular complications in 6% of the patients. Survival at 6 months and 1 year was 86.3% and 84.4%, respectively. NYHA functional class improved significantly after TAVI and remained low in the medium-term follow-up. Conclusions: In this preliminary experience, the treatment of patients with AS and high or prohibitive surgical risk with TAVI, using the CoreValve TM self-expanding system was feasible and safe and
Transcatheter aortic valve implantation: the new option for high-risk patients with aortic stenosis
Cardiology journal, 2011
Calcific aortic valve stenosis is the most common valvular heart disease in developed countries. Without surgery, the prognosis is extremely dismal. Therefore there is general agreement that surgical aortic valve replacement should be offered to patients with symptomatic severe aortic valve stenosis. However, surgery is denied to approx. 30-40% of elderly patients with severe, symptomatic aortic stenosis due to high perioperative risk. Transcatheter aortic valve implantation (TAVI) is a novel and effective procedure which provides a promising treatment option for some of these patients. This review focuses on TAVI systems, the patients who would benefit from TAVI, and the advantages and disadvantages of the procedure.
Experiences of Transcatheter Aortic Valve Implantation with Severe Aortic Stenosis
Haydarpasa Numune Training and Research Hospital Medical Journal, 2018
Introduction: Aortic stenosis is the most common and dangerous native valve disease and it affects 2-4% of the patients over 65 years of age. However, the surgical procedure leads the patients to undergo great risks, especially in the elderly population and in patients with concomitant disorders. In this retrospective study, we described and analyzed our experience on TAVI procedures performed in our hospital. Methods: After the approval of the Ethics Committee to conduct this study, patients' files from June 2012 to December 2014 were reviewed retrospectively and first 100 patients' demographic data, STS, EuroSCORE, aortic valve pressure gradients, the methods of anesthesia and monitoring and postoperative complications were collected. All of the data were expressed as mean±standard deviation. Results: Among 100 remaining patients, on whom data were collected, mean age was found as 78.6±6.7 years and 65 of the patients were female. The mean pulmonary artery pressure was 46.9±14.2 mmHg and mean pressure gradient (PG) was 48.8±10.7 mmHg, whereas the peak PG was 75.5±17.1 mmHg before the TAVI procedure; left ventricular ejection fraction before the TAVI procedure was calculated as 51.2±14.2%. Analysis of the patient charts revealed a mean value for STS as 7.8±4.7 and a mean value for EuroSCORE as 34.9±14.1%. In all patients, a probe for transesophageal echocardiography was inserted for real-time monitoring, together with a temporary pacemaker. Implanted valves were expandable CoreValve in 56%, and the Edwards Sapiens XT Valve in 43%. Following completion of the procedure, final femoral angiography was performed to verify that there were no vascular injuries. The patients were transferred coronary ICU after extubation. During postoperative period, minor complications were encountered in 11% of the patients. Discussion and Conclusion: The findings showed that TAVI was a procedure with a low rate of complications in patients with severe aortic stenosis when the steps of the procedure had been followed meticulously, according to the results of our retrospective study. The anesthesiologist should be a key member of the staff prior, during, and following the intervention. The ongoing prospective trials and retrospective research together with the debate on indications, type of the anesthesia, location where the procedure is held will shed light on the evolvement of this relatively novel technique.
2015
Introduction: Aortic stenosis (AS) is the most common form of heart valve disease in the western world. As the population ages, this disease is becoming an increasing burden on patients and on the health care system. Current drug therapies (medical management (MM)) cannot reverse the course of AS. For most individuals with severe AS, surgical aortic valve replacement (SAVR), which requires open heart surgery and cardiopulmonary bypass, remains the standard therapy. However, a subgroup of patients with aortic stenosis are unsuitable for or at high risk to undergo SAVR due to their frailty or other comorbidities. Transcatheter aortic valve implantation (TAVI)-a novel, less invasive treatment option-was developed as an alternative for patients who are not suitable or at high risk for undergoing surgery. Objective: This study is intended to assess the feasibility, safety, efficacy and clinical effectiveness of TAVI, using the transfemoral (TF) and transapical (TA) approaches, in comparison to medical management or SAVR in patients with severe symptomatic AS; and to compare the outcomes associated with the two different approaches for valve implantation (TF and TA). Methods: A comprehensive literature search was conducted using eight electronic databases to identify studies of TAVI (TF and/or TA) for the treatment of AS. Data from the selected studies were extracted by two reviewers. Outcomes considered were feasibility, safety, efficacy and effectiveness of TAVI. Study quality was assessed and information was tabulated to identify trends or patterns. Results were pooled across studies for each outcome. iii Results: Fifty six relevant studies were identified: 37 studies (including seven comparative studies) assessed clinical outcomes, 14 studies discussed health-related quality of life, and five studies examined the impact of the learning curve on feasibility and safety of TAVI on patient outcomes. The overall procedural success rate was 96% (88%-100%). Studies that examined the learning curve for TAVI demonstrated it had a significant impact-increasing the procedural success rate and decreasing 30-day mortality. The mean combined periprocedural and cumulative all-cause mortality rate at 30 days for TAVI compared to the control groups (MM and/or SAVR) in the same or different studies was 9.0%, n = 10,500 vs 2.8%, n = 179, and 6.7%, n = 302, respectively. Permanent pacemaker implantation was three times more common with the Medtronic CoreValve compared to the Edwards SAPIEN prosthesis (26.5% vs 8.2%), but when both TAVI valves were compared with SAVR, there was no statistically significant difference. Major vascular complications occurred more frequently in the TF group (11.6%) than in the MM, SAVR or the TA groups. The rate of acute kidney injury requiring renal replacement therapy did not differ significantly between the TAVI and control groups, but was three times higher with the TA compared to the TF approach (7.3% vs 2.5%). TAVI achieved significant hemodynamic improvement as measured by echocardiography. The pooled estimate for moderate or severe paravalvular aortic regurgitation after TAVI was 7.2% (with no significant difference between TAVI approaches). Paravalvular aortic regurgitation occurred more frequently with TAVI than with SAVR. One year survival rates ranged from 68% to 77% for TAVI patients in the comparative studies and 72% to 85.3% in the case series studies. For MM and SAVR, the one year iv survival rate was 45% to 49.7% and 73.4% to 83%, respectively. Studies that compared patients' quality of life before and after TAVI found significant improvement at one-year follow-up. Conclusions: TAVI offers a safe and effective treatment for severe aortic stenosis in patients who are not suitable for or are at high risk to undergo SAVR. Unfortunately, current shortcomings in the evidence on long term outcomes make it difficult to determine the effectiveness of TAVI in high risk patients who may be candidates for surgery. v