This document discusses transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement for patients with severe aortic stenosis who are at high risk for or unable to undergo conventional surgery. It defines the levels of aortic stenosis severity based on mean gradient and aortic valve area. It notes that over 30% of patients with severe symptomatic aortic stenosis remain untreated and reviews the indications for TAVI versus conventional surgery. It identifies factors that classify patients as "high risk" or "inoperable" and describes the transfemoral and transapical approaches for TAVI. It concludes that TAVI is associated with acceptable outcomes for this elderly high-risk patient population and that the transapical

1. Transcatheter and transapical
aortic valve implantation TAVI
for patients with aortic valve
stenosis
Darko Majić, dr. med.

2. Degree of aortic stenosis
Mean gradient Aortic valve area
(mmHg) (cm2)
Mild aortic stenosis <25 >1.5
Moderate aortic stenosis 25 - 40 1.0 - 1.5
Severe aortic stenosis >40 < 1.0
Critical aortic stenosis >70 < 0.6

3. Why is surgical AV inplatation needed
at symptomatic AS patients
Because patients…
1. Feel better
2. Have improved LV function
3. Live longer

4. TAVI vs. conventional surgycal AVI
At Least 30% of Patients with severe symptomatic AS
are “Untreated”!
Indications for conventional AVI
•Symptomatic patients with severe AS
•Patients with severe AS undergoing CABG
Indications for TAVI
•Symptomatic patients with severe AS who are
“high risk” for surgery or inoperable

5. Who are the “High Risk”
AS Patients
•Patients with multiple co-morbidities
COPD, diabetes, creatinine, PVD, LVEF,
previous cardiac surgery,)
EuroSCORE>20%

6. Who are the “Inoperable”
AS Patients
Radiation chest wall/heart disease
Chest wall deformities (severe)
End-stage COPD
Cirrhosis with portal hypertension
Porcelain aorta (CT proven)
Degenerative neurocognitive dysfunction
>50% chance of mortality or never leaving
a chronic care facility

8. Balloon valvuloplasty and valve implantation
during rapid ventricular pacing (~180 p/min)
Transfemoral Transapical

9. TAVI complications
Myocardial infarction
Perforation-tamponade
Major vascular complications
Valve migration
Need for permanent pacemaker
Coronary artery obstruction
Conversion to conventional AVI

10. Conclusion
TAVI is associated with acceptable morbidity
and mortality outcomes, considering the
very complex elderly sick patients
Trans-apical approach is acceptable in the
most highly risk patients population
(EuroScore >30%) and could be the solution
for this group of patients.

12. Thanks for Your attention