STATE OF ART ON TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) FOR THE TREATMENT OF AORTIC STENOSIS

Transcatheter Aortic Valve Implantation (TAVI) technique represents a real revolution in the field of interventional cardiology and medicine, in particularly for the treatment of aortic valve stenosis in elderly patients, or in patients when the periprocedural risk for the traditional surgical option is considered too high, as an alternative to the traditional aortic valve replacement. From the year 2002, when Cribier, in France, performed the first transcatheter aortic valve implantation (TAVI), in a period of just over a decade, this technique has become a reality in clinical practice of cardiologists interventionists worldwide. The data of follow-up in the long term are currently available mainly for the valves of the first generation. These data show an excellent, also at long term, hemodynamic performance. Although experience on the valves of the last generation is still limited in time, the data currently available are definitely in the direction of a minimum hospital mortality (1%), as well as to a drastic reduction in the incidence of complications, compared to the devices of the previous generation. Finally, the evolution of specified materials of the newest generation have greatly enhanced safety and efficacy of TAVI procedures in the last year

percutaneous approach to a tight post isthmic aortic coarctation a case report and literature review

Correction: Figure 1 and Figure 2 were omitted from the PDF. On 5th June 2017, the new PDF including the figures was uploaded and the page numbers of the article changed from 41-44 TO 41-45.A 17 years-old boy with hypertension underwent cardiology assessment for episodes of dyspnoea and palpitations. Cardiac angiography showed post-istmic severe aortic coarctation. The malformation was successful treated by implanting a covered stent in aorta. The manuscript describes in detail this case and analyzes the available literature on the topic.Journal of Advances in Internal Medicine Vol.5(2) 2016: 41-4

Prespecified Risk Criteria Facilitate Adequate Discharge and Long‐Term Outcomes After Transfemoral Transcatheter Aortic Valve Implantation

Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST‐TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1‐year after discharge. The end point—a composite of all‐cause mortality, vascular access–related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding—was reached in 27.0% of patients (95% CI, 23.3–31.2) within 1 year after intervention; 7.5% (95% CI, 5.5–10.2) had in‐hospital complications before discharge and 19.6% (95% CI, 16.3–23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular‐access–related complications 0.7%, life‐threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST‐TAVI risk assessment provides a tool for appropriate, risk‐based discharge that was validated with the 1‐year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov ; Unique identifier: NCT02404467

Impact of selected comorbidities on the presentation and management of aortic stenosis

Background: Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. Methods Prospective registry of severe patients with AS across 23 centres in nine European countries. Results Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) = 2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and >= 2 comorbidities;p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and >= 2;p= 2 comorbidities than in those without (8.7%, 10.0% and 15.7%;p= 2 comorbidities (30.8 days) than in those without (35.7 days;p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. Conclusions: Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period