Direct transcatheter aortic valve implantation – one-year outcome of a case control study

Abstract

IntroductionTransaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation.AimTo assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation.Material and methodsOut of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases.ResultsThe procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a CoreValve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 ±14.0 mm Hg to 10.0 ±4.8 mm Hg, p < 0.001; CG: mean TG: from 55.9 ±12.0 mm Hg to 9.9 ±2.9 mm Hg, p < 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 ±0.13 cm2 and CG: 1.67 ±0.25 cm2, p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups.ConclusionsThe direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.

Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

“…Among the studied populations, TAVI was performed without preimplantation BAV in 721 patients and with preimplantation BAV in 674 patients. The mean age was 81.3 years, and 49.6% of participants were female in 14 studies that reported both age and sex . The balloon‐expandable Edwards SAPIEN XT or SAPIEN 3 valve was implanted in 10 studies including 793 patients, and the self‐expandable Medtronic CoreValve was used in 7 studies including 602 patients.…”

Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…

“…Such stimulation allows for reducing the systolic pressure in the left ventricle and its stroke volume. Depending on the patient risk profile, the amount of calcification, and the annulus sizing precision, the balloon valvuloplasty may often be skipped [78]. The implantation technique of the aortic bioprosthesis varies with its type and construction.…”

“…In the case of a very small artery diameter ≤ 5 mm or the presence of extensive atherosclerosis or calcifications, significantly narrowing the vessel lumen, the TAVI team should consider an alternative vascular approach. If no contraindications to general anaesthesia exist, a transthoracic access should be considered [77,78].…”

Prosthetic valve endocarditis after transcatheter CoreValve Evolut R bioprosthesis implantation

“…Prosthetic valve endocarditis (PVE) affects 1–6% of prosthetic valve recipients and in patients treated with transcatheter aortic valve implantation (TAVI) has an incidence of 0.3–2.3% per patient-year [1–3]. …”