Authors

• Zvonimir Ostojić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-1762-9270
• Joško Bulum — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1482-6503
• Maja Strozzi — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-4596-8261
• Ivica Šafradin — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-4519-5940
• Višnja Ivančan — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-7282-9753
• Jadranka Šeparović Hanzevački — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-3437-6407
• Vlatka Resković Lukšić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-4721-3236
• Bojan Biočina — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-3362-9596
• Davor Miličić — University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-9101-1570

Keywords

aortic stenosis, transcatheter aortic valve implantation, outcomes

DOI

Full Text

Transcatheter aortic valve implantation (TAVI) has been shown as adequate modality for treatment of high risk or inoperable patients with severe symptomatic aortic stenosis (AS). (1, 2) In this abstract data concerning TAVI from University Hospital Centers Zagreb are presented. In total 44 TAVI were preformed in our institutions. All decisions regarding performing TAVR instead SAVR were made by „heart team“. Most common indication for TAVI was high surgical risk (71%), followed with porcelain aorta (16%), extensive thorax radiation (9%) and previous SAVR – „valve in valve“ procedure (4%). Of all patients, 31 (70.5%) were female and overall average age was 80.3 years. Average NYHA score was 3 and mean STS-mortality score 5.34. Average maximal gradient across valve before TAVR was 88mmHg with average AVA of 0.66cm2. 39% of patient had coronary artery disease and all of those were treated either with CABG or PCI prior to TAVI. Almost all possible approaches were used (trans-apical, -carotid, direct aortic) but majority of procedures were performed using transfemoral approach (86.4%), from which 71% were done using surgical closure of femoral artery, while in rest of the cases Proscar was used. Valve was successfully implanted in 41 (94%) cases. In those, maximal gradient over aortic valve after TAVI was 19 mmHg followed with significant improvement in functional status. From three patients in whom implantation failed, one had to be converted in rescue SAVR, one is candidate for re-implantation, due to embolization of valve in aorta and last one had persisted sever aortic regurgitation. Five patients had some form of vascular complication; three were connected with vascular access and two had cardiac tamponade. After the procedure 6 patient (13.6%) developed some degree of atrioventricular block, from which 3 required permanent pacemaker implantation. None of the patients developed CVI or myocardial infarction. Overall in hospital mortality was 4.6%, and one-year mortality was 5.5%. When compared to data in larger registries our results are almost the same and in some categories even better. In conclusion, TAVI is adequate treatment option for selected patient with sever AS, but reimbursement issues are main barrier for performing optimal number procedures in Croatia (at least 30/million inhabitants).

Literature

1. Holmes DR, Brennan JM, Rumsfeld JS, Dai D, O’Brien SM, Vemulapalli S, et al. STS/ACC TVT Registry. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015;313(10):1019–28. https://doi.org/10.1001/jama.2015.1474
2. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33(19):2451–96. https://doi.org/10.1093/eurheartj/ehs109