Challenges of transcatheter aortic valve implantation

Introduction: During the last decade, transcatheter aortic valve implantation (TAVI) has become an im-portant alternative to surgical aortic valve replacement in patients with aortic valve stenosis and at high or in-termediate surgical risk.
Objective: We assessed trends in the performance of TAVI in a private hospital from Romania from the first case in December 2016 to April 2018.
Methods: We analysed changes in case mix, complica-tions and outcomes to one year. The inclusion criteria were patients with symptomatic severe aortic stenosis undergoing percutaneous aortic valve replacement. The study includes 27 patients.The mean age was 78.2 years, 59.2% were men (16 patients) and 40.8% female (11 patients). 16 patiens had high surgical risk (with mean Euroscore 12.5% and STS 8.5%).
The Edwards Sapien 3 prosthesis was almost exclu-sively used (for 26 patients). Femural accces was used in 88.9% of cases (only 3 patients had apical access). Although general anesthesia (GA) with transesopha-geal echocardiography guidance was used in 88.9% of cases (24 patients), there is an increase in non-GA methods. Postprocedural mean length of stay was 4,8 days. 18 patients (66.6% of cases) had ischemic heart disease, and 15 of them needed interventional myocar-dial revascularization before TAVI (very complex pro-cedures: 7 patients with two or three vessel coronary disease, 3 patients with left main coronary stenting, 3 patients with severely calcified coronary leasions sol-ved with rotablation). 4 patients needed left main pro-tection during TAVI.
Results: Regarding intra or postprocedural complicati-ons, there were 4 patients (14.8%) with major vascular injury (one acute lower limb ischaemia, two patients with femoral artery pseudoaneurysm, one femoral ar-teriovenous fistula), 2 patients (7.4%) with ventricular septal defect (restrictive membranous VSD with no hemodynamic effect), 2 patients with worsening renal dysfunction (no need for renal replacement therapy), 2 patients with three degree atrioventricular block who required permanent pacemaker implantation. Only 4 patients (14.8%) had mild to moderate paravalvular aortic regurgitation. There were no patients with peri-procedural stroke/cardiac tamponade/aortic dissecti-on, no emergency conversion to surgery. Overall 30-day mortality was 0%. 6 months survival was 94.5%. No hospitalizations for worsening heart failure were noted. Only 8 patients reached the one year follow-up until present. In the first year after TAVI, 7 patients have no deterioration in the functioning of the bioprosthetic valve, as assessed by evidence of stenosis or regurgitati-on on echocardiography. There is only one patient with asymptomatic valve thrombosis.
Conclusions: TAVI significantly reduced the rates of death, repeat hospitalizations and cardiac symptoms. We present our institutional experience with TAVI im-plantation and postprocedural complications. Vascular injury is amongst the commonest complications of this life-saving procedure, even for our group of patients. We are also reporting rare complications after TAVI like ventricular septal defect or late valve thrombosis. Providing better understanding of potential complica-tions, risk factors for these complications, and strate-gies to individualize each patient, the outcomes can be significantly improved.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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