Outcomes of Transcatheter Aortic Valve Implantation in Management of Severe Symptomatic Aortic Stenosis
Outcomes of Transcatheter Aortic Valve Implantation in Management of Severe Symptomatic Aortic Stenosis
TAVI is still a relatively new technique that is emerging with advance in the percutaneous
 and implantable valve technology. Despite its safe use in inoperable and high risk patients
 with severe symptomatic aortic valve stenosis, minimizing complications, predictors of
 outcomes and approach preference is still an area of study. Here we decided to study the
 outcomes of patients undergoing TAVI, different approaches used and their subsequent results
 and complications.
Severe symptomatic aortic stenosis in elderly patients represents a surgical challenge for
 cardiac surgeons due to heavy calcifications and associated comorbidities. Such conditions
 usually are associated with dramatic intra and postoperative complications leading to many
 cases being declined for open surgical replacement. Many treatment modalities were described
 including trans-catheter valvotomy but with only temporary improvements and high rates of
 recurrence.

 Transcatheter Aortic Valve Implantation (TAVI) has offered an alternative solution to such
 cases in which open surgery is deemed too risky or prohibited. Percutaneous Heart Valves
 (PHV) implantations have been experimented on animals since the early 1990s. Yet the first
 human case was not reported till 2002, in which a percutaneously implanted heart valve (PHV)
 composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was
 developed and implanted through the antegrade trans-septal approach in a patient presenting
 with severe calcific aortic stenosis associated with many noncardiac comorbidities including
 leg ischaemia. Despite Patient's death after 17 weeks due to noncardiac causes, his follow-up
 showed significant improvement of left ventricle (LV) function and aortic valve area after
 implantation of the percutaneous valve.

 This case was followed by several single-center and small multicenter registries and series
 that included inoperable or very-high-risk patients, which were associated with promising
 results that confirmed the feasibility of TAVI.

 Many approaches are used for TAVI with the transfemoral approach being the primary option.
 Abnormalities of the iliofemoral anatomy have led to the emergence of other approaches
 including transapical, subclavian, axillary, and transaortic routes. Potential advantages of
 such approaches would be the avoidance of using large catheters though the iliofemoral
 system, aortic arch, ascending aorta, and aortic valve. Yet, their main disadvantage would be
 the need for general anaesthesia.

 As any surgical procedure, TAVI carries some risk of complications, major vascular injuries,
 stroke, conduction abnormalities, myocardial infarction, coronary obstruction and acute
 kidney injury have been reported. Although, careful planning, patient selection,
 perioperative workup and individualised approach choice play an important role in avoiding
 such problems.
Inclusion Criteria:

 -  Patients with severe symptomatic aortic stenosis undergoing TAVI.

 Exclusion Criteria:

 -  Patients with concomitant valvular heart disease.