Transcatheter Aortic Valve Implantation: Our Experience and Review of the Literature

Abstract

Transcatheter Aortic Valve Implantation [TAVI] is widespread worldwide as an alternative therapy procedure to the patients suffering from severe aortic valve stenosis. However, we shouldn't forget that the conventional surgical aortic valve replacement is still the gold standard therapy for severe aortic valve stenosis. For the patients who cannot be treated conventionally because of high risk comorbid diseases and older age, TAVI is an effective alternative therapy method. The indications should be limited, concerning the high mortality rate, 10% within 30 days of intervention. Long term efficacy data are still inadequate. Although the indications are restricted to older patients with a STS score >10 or log-Euro Score >20, age is not a definite indication for this treatment. The patients should be assessed by a heart team including a non-interventional cardiologist, interventional cardiologist, cardiac anesthesiologist and cardiac surgeon according to their general status, frailty and STS- Euro score. In other words, assessment and treatment of the patient by a heart team is the main factor besides the limited power of the scoring systems. The treatment should be applied to the patients with an aortic annulus diameter between 18-27 mm and a life expectancy of at least over 1 year. The currently ongoing investigations are focused on parameters like safety, efficiency and long term reliability of TAVI. The scientific and technical developments lead to new definitions and parameters regarding the treatment indications of severe aortic valve stenosis. In this review, we present the actual data about TAVI and also our own experiences. Turkish Başlık: Kateter İçinden Aort Kapağı İmplantasyonu: Bizim Tecrübelerimiz ve Literatür Derlemesi Anahtar Kelimeler: TAVI, TAVI transfemoral, TAVI transapikal, Kateter yöntemiyle aort kapak implantasyonu, Ağır Aort Kapak Stenozu Aort stenozu tedavisinde kateter yöntemiyle gerçekleştirilen aort kapak implantasyonu [TAVI] hızla yaygınlaşmaktadır. Fakat ileri aort darlığının gold standart tedavi yönteminin halen cerrahi aort valv replasmanı olduğu akılda tutulmalı ve ancak cerrahi olarak opere edilemeyen çok yüksek riskli hastalar TAVI işlemine alınmalıdırlar. Konvansiyonel cerrahi replasmanin komorbid hastalıkları nedeni ile yüksek riskli oldugu yaşlı hasta grubu için TAVI uygun bir alternatif oluşturmaktadir. Endikasyon titizlikle konmalıdır, çünkü bu hastalarda, girişim transkutan olsa da, 30 günlük mortalite yüzde 10 civarındadır. Uzun dönemli takip veriler hala yetersiz olmakla beraber, endikasyon konusunda güncel literatürde 75 yaş üstü hastalar, STS-skoru > 10 veya log Euroskoru > 20 olan hastalarla sınırlı tutulması gerektiği yönünde görüşler olmakla birlikte bu girişim için yaş kesin bir belirleyici değildir. Esas olan hastanın, kardiyolog, girişimsel kardiyolog, anestezist ve kardiyak cerrahtan oluşan bir kalp takımı tarafından değerlendirilmesi ve bu değerlendirmenin sonuçları bağlamında hareket edilmelidir. Anulus genişliği endikasyonda önemli role sahiptir ve bu girişim anulus genişliği 18-27mm arasında olan hastalar ile sınırlandırılmalıdır. Tüm bunların yanında yaşam beklentisi 1 yılın altında olan hastalarda TAVI kontraedikedir. Halen yürütülmekte olan bilimsel çalışmalarda güvenilirlik , verimlilik ve özellikle kapağın uzun dönem dayanıklılığı gibi parametreler araştırılmaktadır. Bu çalismalar ışığında TAVI endikasyonlarına yeni tanımlamalar ve parametreler eklenmektedir.

Keywords

• TAVI, TAVI transfemoral, TAVI transapical, conventional aortic valve implantation, catheter-based aortic valve implantation

Transcatheter Aortic Valve Implantation: Our Experience and Review of the Literature

Öz

Kaynakça

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