New techniques for the treatment of valvular aortic stenosis – transcatheter aortic valve implantation with the SAPIEN heart valve

Abstract

Acquired aortic stenosis (AS) resulting from calcification of the aortic valve is the most frequent acquired valve disease in Europe. Due to the increasing average life expectancy the population in the western industrial world is aging, and consequently the prevalence of AS requiring aortic valve replacement (AVR), particularly in older patients, is continuously increasing. However, the risk of conventional AVR with the use of sternotomy, cardiopulmonary bypass, and cardioplegic cardiac arrest is obviously higher in the elderly patient, in whom significant comorbidities may additionally pre-exist. Moreover, there is recent evidence that 30-40% of the patients with severe and/or symptomatic AS in Europe remain untreated and nearly half of them are considered "too sick" for surgery. Thus, there seems to be a role for less invasive treatment options, like transcatheter aortic valve implantation (TAVI) techniques, addressing an unmet patient and medical need. Today, an increasing number of different transcatheter heart valve devices for aortic valve implantation is coming up; however, so far only for two systems there is broad clinical experience with human implantations. The following article is aimed to describe the current transcatheter aortic valve implantation technique with full details of the procedural steps, both via the transfemoral and via the transapical access using the balloon-expandable SAPIEN transcatheter aortic heart valve device.

Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers

“…The transapical TAVI procedure was performed as previously described [14]. The Edwards SAPIEN™ aortic valve bioprosthesis was used in 13 patients whereas the Symetis™ valve was implanted in 15 patients.…”

Conventional aortic valve replacement or transcatheter aortic valve implantation in patients with previous cardiac surgery

“…Competences of the interdisciplinary heartteam, consisting of cardiac surgeons, cardiologists, anesthesiologists, and perfusionists, complemented in optimal support during the TAVI procedure. The transapical access was performed as previously described by our group [4]. Either the pericardium was opened and adhesiolysis was performed or the pericardium was unaltered, and the correct apical position was then detected by transesophageal echocardiography.…”

Low Incidence of Paravalvular Leakage With the Balloon-Expandable Sapien 3 Transcatheter Heart Valve

“…TRANSAPICAL ACCESS. The transapical access was performed as previously described by our group [8] using 4 pledgedarmed U stitches (Prolene 3-0 [Ethicon, Somerville, NJ], MH needle). Briefly, access to the left ventricular apex was gained through a 4-to-6-cm anterolateral minithoracotomy in the fourth or sixth intercostal space [9].…”