Transcatheter aortic valve implantation

Abstract

Background : Transcatheter aortic valve implantation(TAVI) has recently emerged as a therapeuticalternative for high-risk surgical patients with severe symptomaticaortic valve stenosis and has been shown to improveclinical outcomes and reduce all-cause mortality in thePARTNER Trial. However, there is still no published data onsimilar outcomes in the Lebanon. Objectives : The aim ofthe study is to evaluate the immediate and short-term resultsof transfemoral (TF) and transaortic (TAo) TAVI done in Lebanonwith 6 months follow-up. Methods: From July 2012 tillMarch 2015, 10 consecutive high-risk and intermediate riskpatients with severe symptomatic AS underwent TAVI usingEdwards SAPIEN valve. The mean age was 79.4 ± 6.9 years,logistic EuroSCORE 12.56 ± 11.78 and mean STS 5.71 ±2.44. Patients were equally distributed among genders (50%).The mean ejection fraction (EF) was 50.0 ± 14.9% and meanAV area 0.61 ± 0.1 cm2; mean aortic valve gradient (mAVG)45.6 ± 20.2 mmHg, and AV annulus size 21.8 ± 1.8 mm.Results: TF approach was performed in 9 patients (90%) andTAo in 1 patient (10%). All valves (17 size 26 mm and 25 size23 mm) were implanted successfully. The overall 6-monthsurvival was 80%. Grade I paravalvular aortic regurgitation(AR) was present in 60% of the patients; grade II in 10%while none of the patients developed AR with grade III or VI.The post-procedural mean aortic valve gradient (mAVG) was9.77 ± 3.31 mmHg; EF was 52.5 ± 11.9% and immediatepostoperative complications included only one case of newonsetarrhythmia (AV Block). After 6 months, one patient diedof cardiac arrest following a massive pulmonary embolismwhile another patient died from a fatal stroke following infectiveendocarditis affecting the valve prosthesis. Conclusion:TAVI is a feasible technique for intermediate/high risk AS withhigh success rate and acceptable complications.