Transcatheter aortic valve implantation (TAVI) using the CoreValve prosthesis - initial experience in Královské Vinohrady University Hospital, advantages and pitfalls of the new method
Abstract
Aortic stenosis is the most common type of valvular heart disease in adulthood and transcatheter aortic valve implantation (TAVI) is a new, evolving alternative to standard surgical aortic valve replacement, suitable for high surgical risk patients. We present our initial experience with this method.
The third generation of a self expanding CoreValve Revalving 18 Fr. valve is made up of a nitinol frame and a bioprosthetic valve from the porcine pericardium. We describe the course of the procedure step by step.
From April 2009 to January 2010, we performed the TAVI procedure in 17 patients with severe symptomatic aortic stenoses. Brief cohort characteristics are as follows (mean values): age 81 years, logistic EuroSCORE 21%, aortic valve area index 0.42 cm2/m2, left ventricular ejection fraction 52%.
The procedural success rate was 100%. Thirty-day mortality was 0% and clinical improvement was obvious, with dyspnea improving by at least one NYHA class in all patients.
Our initial experience with TAVI is most encouraging. Success of TAVI requires a team approach to preoperative assessment, a technically precise procedure and meticulous postoperative care.
It is our opinion that a cautious approach to indicating TAVI is needed until its role is confi rmed in a longer follow-up; we can expect less selective use of this method in the future.