TRANSCATHETER AORTIC VALVE IMPLANTATION- NEW INNOVATION IN AORTIC VALVE Replacement

Aortic valve stenosis is the commonest valvular heart disease in western world. An incidence of aortic valve stenosis is increasing as ageing of population. In spite of several option for management of this disorder like observation, medical treatment, balloon valvuloplasty, surgical aortic valve replacement is consider as the gold standard. However, there are 2/3 of patients are consider as high risk for surgical treatment and refused by surgeon for open heart surgery. Therefore, with the ageing of global population, the lengthening in life-expectancy and the consequent growing need to treat elderly patients with severe AS, there is a wide population who would benefit from a less invasive way of replacing the aortic valve. Transcatheter aortic valve implantation (TAVI) allows the aortic valve to be implanted without a sternotomy, with beating heart and without the need for routine cardiopulmonary support. In the present series, we reported our prospective single centre experience about TAVI in a the Department of Cardiovascular Sciences, at the University of Verona, using both balloon expandable Edward-Sapien and self expanding Core-Valve devices, through trans-femoral, trans-apical and sub-clavian approaches. We report on early (30days) and long term follow up results, focusing on both clinical outcome and hemodynamic performance of the devices. We also investigated some peculiar fields of application, such as the treatment of severe aortic insufficiency in Heart Mate II patient, and speculated on the main potential procedural complications, such as the vascular complication and the periprosthesis leakage. 12 In present series we found that procedural success was high. Hemodynamic function of prosthesis was well maintained up to long term follow up. Moreover, neither patient needed emergency conversion to open heart surgery nor underwent aortic valve replacement on long term follow up. Non-cardiac mortality was higher than cardiac causes on both short term and long term follow up. Euroscore II is more predictor of operative mortality then logistic Euroscore. High EuroScore II and heart failure patients are predictor of long term mortality. Vascular complication was most common immediately after procedure. Proper patients screening and selection of proper approach is key to success. Recent improvements in the introducer and delivery system increase the procedural success and decrease complications. We strongly believe that, once some current limitations and concerns are overcome, this emerging technique will have a very fast and wide spread. However, it should not be forgotten that, in order to guarantee the extraordinary success of this new minimally invasive procedure, the heart team approach should remain a key-point. This will allow to select the best device and the most appropriate vascular access for each patient, as well as to guarantee the best technical result and the necessary post-procedural care.