Background and objectiveThe prevalence of aortic stenosis in Saudi Arabia is expected to increase owing to the rise in the life expectancy of the population. Such increase is expected to be met with higher demand for interventions including transcatheter aortic valve implantation (TAVI). In this study, we aimed to identify the outcomes of this procedure among the population of the Western region of Saudi Arabia. MethodsThis was a retrospective observational study involving patients who underwent TAVI at the King Faisal Cardiac Center (KFCC), Jeddah, Saudi Arabia from June 2018 to January 2020. All patients who had undergone TAVI were included, and patients who were lost to follow-up for more than 90 days were excluded. The collected data included sociodemographic characteristics, peri-procedural assessment, and outcomes within 90 days. ResultsThe study included a total of 52 patients. There were 28 males (53.8%) and 24 females (46.2%). The mean age of the cohort was 78 years. Type two diabetes mellitus was present in 67.3%, and hypertension and dyslipidemia were seen in 80.8% of patients. Coronary diseases were seen in 55.8%. The majority had prior percutaneous coronary intervention (PCI) (53.8%) and 3.8% had coronary artery bypass grafting (CABG). Twenty patients (38.5%) had heart failure. Atrial fibrillation was encountered in 13 patients (25%). Chronic kidney disease was described in nine (17.3%) patients, and four (7.7%) were on regular hemodialysis. The median Society of Thoracic Surgery (STS) risk score was 2.4 (IQR: 1.97-5). High STS scores (>8) were only seen in 9% of the patients. The success rate was 98%, and the in-hospital mortality rate was 3.8%. Vascular complications were seen in eight patients (15.4%), and the majority of them were minor. One patient (1.9%) had a major vascular complication. There was a tendency toward high blood transfusions (19.2%). Clinically manifest stroke was seen in three patients (5.8%). Eight patients (15.4%) had post-procedure complete heart block (CHB). Endocarditis was seen in two patients (3.8%). Thirty-day cardiac readmission was observed in 17.3% of patients, and acute kidney injury was seen in eight patients (15.4%). Mild aortic regurgitation was seen in 51.9% of the patients, but moderate or severe aortic insufficiency (AI) was not encountered. ConclusionTransfemoral TAVI using a self-expandable valve is a safe and feasible procedure at KFCC, an intermediatesized center. Our data is comparable to local and international centers of similar size. Program sustainability depends on the development of robust referral networks and implementing regulatory quality and patient safety standards.

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A case study of 70 year old male patient with a history of long standing diabetes mellitus (DM), hypertension, dyslipidemia, peripheral vascular disease, severe ischemic cardiomyopathy with LV ejection fraction of 20% and a left bundle branch block. He presented to the ER complaining of retrosternal chest pain for less than 6 hours associated with shortness of breath, orthopnea and diaphoresis. No paroxysmal nocturnal dyspnea or leg swelling. His medication used at home were aspirin 81 mg, carvidelol 12.5 mg twice daily, Lisinopril 5 mg daily, Lasix 60 mg daily, Lipitor 20 mg daily and spironolactone12.5 mg. On exam, he was diaphoretic, distressed and in pain; his blood pressure was 93/60 mmHg. His heart rate was 65 pbm-regular; jugular venous pressurewas elevated. His cardiovascular examination showed normal S1, reverse splitting of S2 and soft systolic murmur at the apex (grade 2/6) radiating to the axilla. His chest exam revealed crackles that are less than 25% of his lung.The rest of his examination was unremarkable. His immediate electrocardiogram (ECG) is shown below (Figure 1). The on call doctor arranged another ECG to help him in the diagnosis (Figure 2). Questions 1) What abnormalities are seen in the first ECG (Figure 1) 2) What's different about the second ECG and what abnormalities it reveals? 3) What is the diagnosis?

A case study of 70 year old male patient with a history of long standing diabetes mellitus (DM), hypertension, dyslipidemia, peripheral vascular disease, severe ischemic cardiomyopathy with LV ejection fraction of 20% and a left bundle branch block. He presented to the ER complaining of retrosternal chest pain for less than 6 hours associated with shortness of breath, orthopnea and diaphoresis. No paroxysmal nocturnal dyspnea or leg swelling.His medication used at home were aspirin 81 mg, carvidelol 12.5 mg twice daily, Lisinopril 5 mg daily, Lasix 60 mg daily, Lipitor 20 mg daily and spironolactone12.5 mg.On exam, he was diaphoretic, distressed and in pain; his blood pressure was 93/60 mmHg. His heart rate was 65 pbm -regular; jugular venous pressurewas elevated. His cardiovascular examination showed normal S1, reverse splitting of S2 and soft systolic murmur at the apex (grade 2/6) radiating to the axilla. His chest exam revealed crackles that are less than 25% of his lung.The rest of his examination was unremarkable. His immediate electrocardiogram (ECG) is shown below (Figure 1). The on call doctor arranged another ECG to help him in the diagnosis (Figure 2). Questions1) What abnormalities are seen in the first ECG (Figure 1)2) What's different about the second ECG and what abnormalities it reveals?3) What is the diagnosis?