Transcatheter and transapical aortic valve implantation TAVI for patients

with aortic valve stenosis

Darko Majić, dr. med.

Degree of aortic stenosis

Mean gradient Aortic valve area (mmHg) (cm2)

Mild aortic stenosis <25 >1.5Moderate aortic stenosis 25 - 40 1.0 - 1.5Severe aortic stenosis >40 < 1.0Critical aortic stenosis >70 < 0.6

Because patients… 1. Feel better 2. Have improved LV function 3. Live longer

Why is surgical AV inplatation needed at symptomatic AS patients

At Least 30% of Patients with severe symptomatic AS are “Untreated”!Indications for conventional AVI•Symptomatic patients with severe AS•Patients with severe AS undergoing CABGIndications for TAVI•Symptomatic patients with severe AS who are“high risk” for surgery or inoperable

TAVI vs. conventional surgycal AVI

•Patients with multiple co-morbidities

COPD, diabetes, creatinine, PVD, LVEF,

previous cardiac surgery,)

EuroSCORE>20%

Who are the “High Risk”AS Patients

Radiation chest wall/heart disease Chest wall deformities (severe) End-stage COPD Cirrhosis with portal hypertension Porcelain aorta (CT proven) Degenerative neurocognitive dysfunction >50% chance of mortality or never leaving

a chronic care facility

Who are the “Inoperable”AS Patients

Transfemoral Transapical

Balloon valvuloplasty and valve implantation during rapid ventricular pacing (~180 p/min)

Myocardial infarctionPerforation-tamponade Major vascular complications Valve migration Need for permanent pacemaker Coronary artery obstructionConversion to conventional AVI

TAVI complications

TAVI is associated with acceptable morbidity and mortality outcomes, considering the very complex elderly sick patients

Trans-apical approach is acceptable in the most highly risk patients population (EuroScore >30%) and could be the solution for this group of patients.

Conclusion

Thanks for Your attention