Percutaneous Aortic Valve Replacement for patients not considered good candidates for the traditional surgical procedure and affected by severe stenosis of the aortic valve.
TAVI: Trancatheter Aortic Valve Implantation is a procedure which can save lives.
The results of the PARTNER Trial recently presented at TCT in Washington have shown a significant reduction in mortality at 1 year for the patients treated with TAVI compared to patients treated with medical therapy and with aortic balloon valvuloplasty. The advantage for TAVI was quite impressive with only 5 patients needed to be treated in order to save one live. The progress of the TAVI valve delivery systems have been quite remarkable since the completion of PARTNER.
In Europe the Edwards Sapien valve is available with a smaller femoral introducer of 18/19 French and the Medtronic CoreValve has now a new delivery catheter which gives a more precise positioning. The experience of the Milan Team working at San Raffaele Hospital and at Columbus Hospital is now over 250 patients treated with a 30 day mortality below 5%.
The procedure is performed with percutaneous transfemoral access in most of the patients. For individuals with poor peripheral vascular access the implantation of the CoreValve utilizing the transaxillary approach is now an alternative.
Most of the procedures are performed without general anesthesia and on the average patients are discharged within 3 days from the procedure.
Screening to evaluate the feasibility of the procedure includes a Multislice Computer Tomography of the vascular system, transthoracic echo and if needed transesophageal echo.
If nor available at the time of Hospital admission these test can be performed in the Hospital in one or two days and the procedure can be performed on day 3.