Multidisciplinary modern approach in treatment patients with aortic stenosis and severe sistolic dysfunction

Introduction: The management of aortic valve disease remains a continuous preoccupation, has been improved because of a correct diagnostic, correct evaluation of severity and progression of the disease, with establi-sh of the right timing for valvular replacement. There are some patients with late presentation, severe systo-lic dysfunction, with severe heart failure class III-IV NYHA, high risk for conventional heart surgery, and TAVI become more and more accessible.
Methods: In our presentation we want to illustrate 2 cases, pacients with severe aortic stenosis and severe systolic dysfunction, in which the multidisciplinary team work with a better outcome for function and clinic.
Case presentation: First case is a patient of 67 years old with aortic stenosis, severe systolic dysfunction, ejection fraction 20%, symptomatic heart failure class III-IV. Patient was in sinus rhythm, normal QRS, first degree heart block, paroxistic atrial fibrillation. Paci-ent was proposed for TAVI. The procedure has a com-plication total occusion of right coronary artery, with complete heart block, ventricular fibrillation. The team proceed with angioplasty and intraostial implantation of stent. Postprocedure, patient stable, maintain major left bundle branch block, EF 25-30%. After TAVI, was implanted a defibrillator with resyncronisation. Good evolution for the patient, recover of systolic function to EF 45-50%.
Second case is about young male 46 years old, 6 years ago suffered aortic valve replacement, bicuspid stenotic valve, with a biological prosthesis, patient having seve-re systolic dysfunction EF 30%, and major left bundle branch block. After 6 years he presented with severe aortic stenosis, major LBBB, heart failure class IV, EF 20%. After evaluation, echo parameters and age of the patient, team decide to resyncronise the patient first and after perform conventional cardiac surgery, aortic valve replacement with a metallic prosthesis. Evolution was good wit raise in cardiac function EF 40-45% .
Conclusions: So, we want to show importance of a multidisciplinary team in approach in pacients with aortic stenosis and severe systolic dysfunction.

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)