Endovascular treatment of severe symptomatic aortic stenosis – TAVR: a single center experience

Introduction: Transcutaneous aortic valve replacement (TAVR) is the last modern treatment alternative for patients (pts) with severe aortic stenosis (AS) and high surgical risk due to major comorbidities. Methods: Between Jan 2013 and Apr 2014 we assessed for TAVR 10 pts with severe AS and a EuroScore > 20. Three pts were selected for TAVR by transfemoral approach. Case#1: M, 63 yo, orthopneic, NYHA class IV; permanent AFib, 2-vessel CAD; COPD Gold class IV. Severe biventricular dysfunction (LVEF = 25%, TAPSE = 10 mm) and PHT = 65 mmHg. He received two CoreValve nr29. Case#2: F, 75 yo, NYHA class IV, anasarca; permanent AFib with slow ventricular rate; severe PHT=70mmHg, RV dysfunction (TAPSE=15mm) and eGFR = 57ml/min; BMI = 48.5 kg/m2. She received a CoreValve nr29. Case#3: M, 72yo, NYHA class III. He had 2-vessel CAD, previous inferior MI and NSTEMI with moderate LV dysfunction (LVEF = 40%). His eGFR = 50 ml/min. A CoreValve nr29 was implanted. Results: All pts had transesophageal echocardiography, coronary angiography, aortography and MSCT of the aorta. All pts had excellent short and medium term outcome. No systemic of cerebral embolic events were noted during the procedure or at FU. No worsening of renal dysfunction was observed in any pts. Pt#3 was left on dual antiplatelet therapy alone. Pts#1 and 2 were left on chronic OAC due to permanent AFib. A permanent VVI PM was implanted in pt#2 due to low spontaneous AFib, not related to the procedure. Conclusions: TAVR is a safe treatment option for high risk surgical pts with severe AS. HeartTeam assessment of all candidates allows good selection of pts for TAVR. The procedure is associated with low peri-operative comorbidity. A full assessment of pts in a single center should be performed prior to intervention.

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)