Transcatheter aortic valve implantation

Česká verzia

Authors: J. Vojáček ¹; J. Šťásek ¹; J. Bis ¹; M. Brtko ²; J. Vojáček ²; J. Harrer ²
Authors place of work: 1. interní klinika LF UK a FN Hradec Králové ¹; Kardiochirurgická klinika LF UK a FN Hradec Králové ²
Published in the journal: Kardiol Rev Int Med 2009, 11(3): 143-147

Summary

Surgical replacement of aortic valve is the treatment of choice in patients with symptomatic aortic stenosis or stenosis causing impairment of left ventricular function. The procedure is in indicated cases performed with low mortality and good long‑term outcome, even in older patients. Aortic valve replacement increases survival in a number of operated subgroups. Transcatheter Aortic Valve Implantation (TAVI) has been developing fast over the recent years as an option in patients in whom the traditional surgical aortic valve replacement would represent a too high risk. This technique is indicated in patients with high EuroSCORE (above 10–20), most often as a result of co-morbidities or of other reasons, for example as a consequence of previous cardiac surgery (most frequently previous coronary revascularization with functional bypass). Success of the procedure depends on operator‘s experience and exceeds 90%. Aortic valve gradient falls to near zero values immediately after the implantation and aortic valve area of 1.5–1.8 sqcm is being achieved; mild to moderate, mostly paravalvular, aortic regurgitation is observed in about half of the patients. The incidence of severe aortic regurgitation has fallen below 5% following improved implant selection. 30-day mortality is 5–18%, the incidence of acute myocardial infarction 2–11%. The incidence of vascular complications (between 10–15%) and conduction disorders with the need for pacemaker implantation in patients treated with self-expanding valve remain an issue.

Keywords:
aortic stenosis – transcatheter treatment – transcatheter aortic valve implantation

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