Transcatheter aortic valve implantation Acute and 6-month outcomes of the first Lebanese experience & a literature review

N° 65-1 (2017) - Pages 7-14

Essa H. HARIRI, Ahmad A. HACHEM, Nibal R. CHAMOUN, Elie K. HADDAD, Diana F. TAMER, Christelle M. LTEIF, Ahmad S. NAJA, George A. SARKIS, Georges Y. GHANEM

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Background: Transcatheter aortic valve im- plantation (TAVI) has recently emerged as a therapeutic alternative for high-risk surgical patients with severe symp- tomatic aortic valve stenosis and has been shown to im- prove clinical outcomes and reduce all-cause mortality in the PARTNER Trial. However, there is still no published data on similar outcomes in the Lebanon.

Objectives: The aim of the study is to evaluate the immediate and short-term results of transfemoral (TF) and transaortic (TAo) TAVI done in Leb- anon with 6 months follow-up.

Methods: From July 2012 till March 2015, 10 consecutive high-risk and intermediate risk patients with severe symptomatic AS underwent TAVI using Edwards SAPIEN valve. The mean age was 79.4 ± 6.9 years, logistic EuroSCORE 12.56 ± 11.78 and mean STS 5.71 ± 2.44. Patients were equally distributed among genders (50%). The mean ejection fraction (EF) was 50.0 ± 14.9% and mean AV area 0.61 ± 0.1 cm2; mean aortic valve gradient (mAVG) 45.6 ± 20.2 mmHg, and AV annulus size 21.8 ± 1.8 mm.

Results: TF approach was performed in 9 patients (90%) and TAo in 1 patient (10%). All valves (17 size 26 mm and 25 size 23 mm) were implanted successfully. The overall 6-month survival was 80%. Grade I paravalvular aortic regurgitation (AR) was present in 60% of the patients; grade II in 10% while none of the patients developed AR with grade III or VI. The post-procedural mean aortic valve gradient (mAVG) was 9.77 ± 3.31 mmHg; EF was 52.5 ± 11.9% and immediate postoperative complications included only one case of new- onset arrhythmia (AV Block). After 6 months, one patient died of cardiac arrest following a massive pulmonary embolism while another patient died from a fatal stroke following infec- tive endocarditis affecting the valve prosthesis. Conclusion: TAVI is a feasible technique for intermediate/high risk AS with high success rate and acceptable complications.

Keywords: transcatheter aortic valve implantation (TAVI), aortic stenosis, PARTNER

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