Cardiologie clinique et expérimentale
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Currently Applied Non-Surgical Techniques for Treatment of Severe Aortic Stenosis in Inoperable High-Risk Adult Patients

Salah AM Said

Background: Patients with severe valvular heart disease associated with significant comorbidities have a high risk to undergo conventional surgical replacement procedures. Alternative catheter-based endovascular interventions have recently been developed to treat such a group of patients.
Aim: To review the indications, short- and long-term outcome, success rate and complications of transcatheter aortic valve implantation (TAVI).
Materials and method: A case with severe aortic stenosis and significant comorbidities is presented and the literature is reviewed regarding the currently applied TAVI.
Results: Presented is a 63-year man with severe aortic valve stenosis and significant concomitant disorders including diabetes, multifactorial anaemia, chronic renal impairment, chronic obstructive pulmonary disorder, peripheral arterial disease and bilateral renal carcinoma. The patient was eligible for TAVI but had inaccessible vascular approach. Transapical and transaortic access were excluded because of poor respiratory function. Medical treatment was continued. Recent data from international literature showed that the success rate of TAVI varied from 83.1% to 100%, complications such as vascular and conduction disorders were between 3.3-18% and 0-34.4%, respectively and the reported 30-day mortality rate ranged from 0% to15.2% in different series.
Conclusions: Our patient with severe aortic stenosis and significant comorbidities had a high-risk for conventional aortic valve replacement and was inaccessible for TAVI. He remained on medical treatment. The TAVI procedure in eligible patients is safe and efficacious with not infrequent procedure-related complications due to advanced age, pre-existent poor conditions of respiratory and renal systems and co-morbidities of the selected subjects.