Ethem KAVUKÇU, Ali ERDOĞAN, Ritvan CHASAN, Nedim SOYDAN, Kamil Mehmet BURGAZLI, Christiane NEUHOF, Mehmet BİLGİN

Transcatheter aortic valve implantation: Our experience and review of the literature

Aort stenozu tedavisinde kateter yöntemiyle gerçekleştirilen aort kapak implantasyonu [TAVI] hızla yaygınlaşmaktadır. Fakat ileri aort darlığının gold standart tedavi yönteminin halen cerrahi aort valv replasmanı olduğu akılda tutulmalı ve ancak cerrahi olarak opere edilemeyen çok yüksek riskli hastalar TAVI işlemine alınmalıdırlar. Konvansiyonel cerrahi replasmanin komorbid hastalıkları nedeni ile yüksek riskli oldugu yaşlı hasta grubu için TAVI uygun bir alternatif oluşturmaktadir. Endikasyon titizlikle konmalıdır, çünkü bu hastalarda, girişim transkutan olsa da, 30 günlük mortalite yüzde 10 civarındadır. Uzun dönemli takip veriler hala yetersiz olmakla beraber, endikasyon konusunda güncel literatürde 75 yaş üstü hastalar, STS-skoru > 10 veya log Euroskoru > 20 olan hastalarla sınırlı tutulması gerektiği yönünde görüşler olmakla birlikte bu girişim için yaş kesin bir belirleyici değildir. Esas olan hastanın, kardiyolog, girişimsel kardiyolog, anestezist ve kardiyak cerrahtan oluşan bir kalp takımı tarafından değerlendirilmesi ve bu değerlendirmenin sonuçları bağlamında hareket edilmelidir. Anulus genişliği endikasyonda önemli role sahiptir ve bu girişim anulus genişliği 18-27mm arasında olan hastalar ile sınırlandırılmalıdır. Tüm bunların yanında yaşam beklentisi 1 yılın altında olan hastalarda TAVI kontraedikedir. Halen yürütülmekte olan bilimsel çalışmalarda güvenilirlik , verimlilik ve özellikle kapağın uzun dönem dayanıklılığı gibi parametreler araştırılmaktadır. Bu çalismalar ışığında TAVI endikasyonlarına yeni tanımlamalar ve parametreler eklenmektedir.

Kateter içinden aort kapağı implantasyonu: Bizim tecrübelerimiz ve literatür derlemesi

Transcatheter Aortic Valve Implantation [TAVI] is widespread worldwide as an alternative therapy procedure to the patients suffering from severe aortic valve stenosis. However, we shouldn't forget that the conventional surgical aortic valve replacement is still the gold standard therapy for severe aortic valve stenosis. For the patients who cannot be treated conventionally because of high risk comorbid diseases and older age, TAVI is an effective alternative therapy method. The indications should be limited, concerning the high mortality rate, 10% within 30 days of intervention. Long term efficacy data are still inadequate. Although the indications are restricted to older patients with a STS score >10 or log-Euro Score >20, age is not a definite indication for this treatment. The patients should be assessed by a heart team including a non-interventional cardiologist, interventional cardiologist, cardiac anesthesiologist and cardiac surgeon according to their general status, frailty and STS- Euro score. In other words, assessment and treatment of the patient by a heart team is the main factor besides the limited power of the scoring systems. The treatment should be applied to the patients with an aortic annulus diameter between 18-27 mm and a life expectancy of at least over 1 year. The currently ongoing investigations are focused on parameters like safety, efficiency and long term reliability of TAVI. The scientific and technical developments lead to new definitions and parameters regarding the treatment indications of severe aortic valve stenosis. In this review, we present the actual data about TAVI and also our own experiences.

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1. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002;106:3006-8 [CrossRef]
2. Piazza N, Wenaweser P, van Gameren M, Pilgrim T, Tsikas A, Otten A, et al. Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System - A Bern- Rotterdam Study. Am Heart J 2010;159:323-9. [CrossRef]
3. Kalvrouziotis D, Li D, Buth KJ, Le´gare´ J-F. The European System for cardiac Operative Risk Evaluation (EuroSCORE) is not appropriate for withholding surgery in high-risk patients with aortic stenosis: a retrospective cohort study. J Cardiothorac Surg 2009;4:32. [CrossRef]
4. Zajarias A, Cribier AG. Outcomes and safety of percutaneous aortic valve replacement. J Am Coll Cardiol 2009;53:1829-36. [CrossRef]
5. Piazza N, van Gameren M, Ju¨ni P, Wenaweser P, Carrel T, Onuma Y, et al. A comparison of patient characteristics and 30-day mortality outcomes after transcatheter aortic valve implantation and surgical aortic valve replacement for the treatment of aortic stenosis: a two-centre study. EuroIntervention 2009;5:580-8. [CrossRef]
6. Ramaraj R, Sorrell VL. Degenerative aortic stenosis. Br Med J 2008;336:550-5. [CrossRef]
7. Lung B, Cachier A, Baron G, Messika-Zeitoun D, Delahaye F, Tornos P, et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? Eur Heart J 2005;26:2714-20. [CrossRef]
8. Walther T, Kempfert J, Borger MA, Fassl J, Falk V, Blumenstein J, et al. Human minimally invasive off-pump valve-in-a-valve implantation. Ann Thorac Surg 2008;85:1072-3. [CrossRef]
9. Frerker C, Schäfer U, Schewel D, Krüger M, Malisius R, Schneider C, et al. Percutaneous approaches for mitral valve interventions- -a real alternative technique for standard cardiac surgery? Herz 2009;34:444-50. [CrossRef]
10. Hara H, Pedersen WR, Ladich E, Mooney M, Virmani R, Nakamura M, et al. Percutaneous balloon aortic valvuloplasty revisited: Time for a renaissance? Circulation 2007;115:e334-8. [CrossRef]
11. Lung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease 1. Eur Heart J 2003;24:1231-43. [CrossRef]
12. Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of endstage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol 2004;43:698-703. [CrossRef]
13. Grube E, Laborde JC, Gerckens U, Felderhoff T, Sauren B, Buellesfeld L, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: The Siegburg first-in-man study. Circulation 2006;114:1616-24. [CrossRef]
14. Heistad DD, Wakisaka Y, Miller J, Chu Y, Pena-Silva R. Novel aspects of oxidative stress in cardiovascular diseases. Circ J 2009;73:201-7. [CrossRef]
15. Linhartová K, Veselka J, Sterbáková G, Racek J, Topolcan O, Cerbák R. Parathyroid hormone and vitamin D levels are independently associated with calcific aortic stenosis. Circ J 2008;72:245-50. [CrossRef]
16. Ross J Jr, Braunwald E. Aortic stenosis. Circulation 1968;38:61-7. [CrossRef]
17. Roberts WC, Ko JM, Filardo G. Comparison of heavier versus lighter operatively excised stenotic aortic valves in adults with aortic stenosis and implications for percutaneous aortic valve implantation without replacement. Am J Cardiol 2009;104:393- 405. [CrossRef]
18. Webb JG, Chandavimol M, Thompson CR, Ricci DR, Carere RG, Munt BI, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 2006;113:842-50. [CrossRef]
19. Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, et al. Thirty-day results of the SAPIEN aortic bioprosthesis european outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 2010;122:62-9. [CrossRef]
20. Piazza N, Grube E, Gerckens U, den Heijer P, Linke A, Luha O, et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18Fr) CoreValve ReValving system: Results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention 2008;4:242-9. [CrossRef]
21. Piazza N, Onuma Y, Jesserun E, Kint PP, Maugenest AM, Anderson RH, et al. Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. JACC Cardiovasc Interv 2008;1:310-6. [CrossRef]
22. Fraccaro C, Napodano M, Tarantini G, Gasparetto V, Gerosa G, R, Bonato R, et al. Expanding the eligibility for transcatheter aortic valve implantation the trans-subclavian retrograde approach using: The III generation CoreValve ReValving system. JACC Cardiovasc Interv 2009;2:828-33. [CrossRef]
23. Olsen LK, Engstrøm T, Søndergaard L. Transcatheter valve-invalve implantation due to severe aortic regurgitation in a degenerated aortic homograft. J Invasive Cardiol 2009;21:E197-200.
24. Hara H, Schwartz RS. Transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis. Circulation Journal 2010;74:1513-7. [CrossRef]