Abstract
Conventional aortic valve replacement using biological or mechanical valve prosthesis is the gold standard in the treatment of acquired aortic valve diseases. The combination of leaflet removal, annulus decalcification and implantation of the prosthesis yields in excellent long time results. Even in octogenarians mortality and postoperative morbidity are in an acceptable range.
Over 3 decades more than 30% of all patients with severe aortic valve stenosis got no valve surgery because they were not suitable for open-heart surgery. In addition the increase of live expectancy is followed by an increasing prevalence of significant degenerative aortic valve stenosis.
Since 2002 a new therapeutic concept was established: the so called catheter based aortic valve implantation.
These procedures have some special features:
- Patients who couldn’t be operated conventionally because of severe comorbidities,
- new cooperation between cardiologist and heart surgeons,
- special post interventional complications with suitable management,
- specific equipment (hybrid OR, interventional training for reduction of learning curve)
The crucial precondition doing TAVI is the formation of an interdisciplinary team consisting in cardiology, cardiac surgery, anesthesia, perfusionists and nurses.
The second important point for success is an exact patient selection followed by certain criteria as well as an exact preoperative diagnosis especially with CT-scans.
The procedure for itself can be down transfemoral, transapical or transaxillar
Published results are promising good midterm durability and low risk of complication of the procedure.
In conclusion, TAVI is a good alternative in high and meanwhile medium risk patients if finding of indication and performance of the procedure is done by a special heart team.
Over 3 decades more than 30% of all patients with severe aortic valve stenosis got no valve surgery because they were not suitable for open-heart surgery. In addition the increase of live expectancy is followed by an increasing prevalence of significant degenerative aortic valve stenosis.
Since 2002 a new therapeutic concept was established: the so called catheter based aortic valve implantation.
These procedures have some special features:
- Patients who couldn’t be operated conventionally because of severe comorbidities,
- new cooperation between cardiologist and heart surgeons,
- special post interventional complications with suitable management,
- specific equipment (hybrid OR, interventional training for reduction of learning curve)
The crucial precondition doing TAVI is the formation of an interdisciplinary team consisting in cardiology, cardiac surgery, anesthesia, perfusionists and nurses.
The second important point for success is an exact patient selection followed by certain criteria as well as an exact preoperative diagnosis especially with CT-scans.
The procedure for itself can be down transfemoral, transapical or transaxillar
Published results are promising good midterm durability and low risk of complication of the procedure.
In conclusion, TAVI is a good alternative in high and meanwhile medium risk patients if finding of indication and performance of the procedure is done by a special heart team.
Keywords
TAVI
AVR
