Transcatheter aortic valve implantation (TAVI)

BACKGROUND: Percutaneous transcatheteraortic valve implantation (TAVI) is a new therapeutic method forpatients with severe symptomatic aortic stenosis who are at veryhigh surgical risk or in whom there are contraindications to surgicalvalve replacement. PATIENTS AND METHODS: Between August2008 and December 2009, sixty such patients underwent TAVI at ourhospital. RESULTS: The mean age of the patientswas 82 ± 6.1 years, 25 of them were men. The mean „Europeansystem for cardiac operative risk” (EuroSCORE) was 25.8 ± 17.0%.A very high surgical risk was the indication for TAVI in 51 patients.The mean aortic valve orifice area was 0.6 ± 0.1cm 2 and the mean transvalvulargradient 48.2 ± 14.4 mm Hg before the intervention. The meanduration of the intervention was 62.6 ± 19.9 minutes and the screeningtime 11.8 ± 5.1 minutes. The procedure was technically successful inall but one patient. The post-interventional mean transvalvulargradient was 2.87.0 mm Hg. Significant residual aorticregurgitation (more than grade 3) was present in six patients butwas reduced by the catheter-based „snare” techniquein most cases. Mean hospital stay was 15.4 ± 18.9 days. A permanentpacemaker was implanted in 22 of the patients. Eight patients diedduring the hospital stay, most of them for reasons not directlyrelated to the intervention. CONCLUSIONS: TAVI is becoming a newtherapeutic method for elderly patients with severe co-morbiditiesand severe symptomatic aortic stenosis. Complications of TAVI arenot trivial and their management by catheter techniques is challenging.In consequence the selection of patients and of suitably experiencedhospitals is crucial for the further development of this promisingnew technique.