Transcatheter aortic valve implantation (TAVI): A new therapeutic option for patients with severe symptomatic aortic stenosis who are not suitable or at high risk for surgical valve replacement

Background: Percutaneous transcatheter aortic valve implantation (TAVI) is a new therapeutic method for patients with severe symptomatic aortic stenosis who are at very high surgical risk or in whom there are contraindications to surgical valve replacement. Patients and methods: Between August 2008 and December 2009, sixty such patients underwent TAVI at our hospital. Results: The mean age of the patients was 82 +/- 6.1 years, 25 of them were men. The mean, European system for cardiac operative risk" (EuroSCORE) was 25.8 +/- 17.0%. A very high surgical risk was the indication for TAVI in 51 patients. The mean aortic valve orifice area was 0.6 +/- 0.1cm(2) and the mean transvalvular gradient 48.2 +/- 14.4 mm Hg before the intervention. The mean duration of the intervention was 62.6 +/- 19.9 minutes and the screening time 11.8 +/- 5.1 minutes. The procedure was technically successful in all but one patient. The post-interventional mean transvalvular gradient was 2.8 +/- 7.0 mm Hg. Significant residual aortic regurgitation (more than grade 3) was present in six patients but was reduced by the catheter-based "snare" technique in most cases. Mean hospital stay was 15.4 +/- 18.9 days. A permanent pacemaker was implanted in 22 of the patients. Eight patients died during the hospital stay, most of them for reasons not directly related to the intervention. Conclusions: TAVI is becoming a new therapeutic method for elderly patients with severe co-morbidities and severe symptomatic aortic stenosis. Complications of TAVI are not trivial and their management by catheter techniques is challenging. In consequence the selection of patients and of suitably experienced hospitals is crucial for the further development of this promising new technique.