Transcatheter aortic valve implantation – diagnostic, procedure and outcomes


Authors: Marián Kurečko;  Gabriel Valočik;  Marianna Vachalcová;  Mariana Dvorožňáková
Authors‘ workplace: Klinika kardiológie VUSCH, a. s., Košice, Slovenská republika, prednosta MUDr. Stanislav Juhás, CSc.
Published in: Vnitř Lék 2015; 61(7-8): 641-648
Category: Reviews

Overview

Transcatheter aortic valve implantation (TAVI) is an interventional method for the treatment of severe aortic stenosis. TAVI is indicated in patients who have been identified by the heart team as surgically inoperable or operable at very high risk. The advantage is minimal invasive approach with the absence of sternotomy and extracorporeal blood circulation. Interventional procedure does not allow direct visualization of the anatomical relations at the site of the final valve position (aortic anulus). For this reason it is essential to ensure appropriate view by high quality imaging methods. A standard method for the evaluation of the anatomical relations before TAVI is multidetector computed tomography (MDCT) with 3D reconstruction. In the future, the MDCT would be replaced by three-dimensional transesophageal echocardiography (3D TEE), which does not require ionizing radiation, there is no postcontrast nephropathy and hypersensitive reaction to iodine compared to MDCT. Furthermore, it provides direct measurements during the procedure and ensures easier and cheaper dispensarisation of the patients. A multicenter randomized PARTNER trial clearly demonstrated significant benefits of inoperable patients with severe aortic stenosis treated by TAVI. Recently published CoreValve US Pivotal randomized trial demonstrated higher efficiency and safety of TAVI in direct comparison with surgical treatment. The aim of this review is to provide current knowledge of TAVI, preparation of the patients before the intervention, the process of intervention, dispensarisation, as well as affecting the quality of patients life.

Key words:
aortic anulus – aortic valve – heart team – multidetector computed tomography (MDCT) – three-dimensional transesophageal echocardiography (3D TEE) – transcatheter aortic valve implantation (TAVI)


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