Aim. To evaluate immediate single-center results of transcatheter aortic valve implantation (TAVI) with use of novel self-expanding bioprosthesis Acurate neo.Material and methods. TAVI procedure was performed in 69 high-tointermediate surgical risk patients (mean age 76,8±6,1years, 31 males, 68 females) with severe calcified aortic stenosis and diverse comorbidity. Concomitant coronary artery disease was observed in 43 (62%), atrial fibrillation in 23 (33%), diabetes mellitus type 2 in 26 (38%) patients. Median Euroscore II was 4,9 (2,8; 9,0). VARC-2 criteria were applied to assess early effectiveness and safety of the procedure.Results. There were no all-cause mortality, surgical conversion, acute coronary syndrome and stroke in the study group. In-hospital and 30-day mortality was also 0%. Duration of the procedure was 100 min (75;120), hospital stay — 7 (6;8) days. Patient’s haemodynamics and clinical status were significantly improved after TAVI. Mean aortic valve pressure gradient significantly decreased from 57,4±17,6 to 11,8±4,4 mm Hg, effective aortic valve area increased from 0,65±0,17 up to 1,8±0,41 mm Hg (p<0,001). Left ventricle ejection fraction increased from 54,5±13,2 mm Hg to 57,7±12,3 before discharge (p<0,001). Moderate paravalvular aortic regurgitation was observed in only 13% of patients. Permanent pacemaker rate was 5,8%. NYHA class reduced from 2,9 to 2,0 (p<0,001).Conclusion. First Russian prospective study of TAVI with use of Acurate neo showed satisfactory hemodynamic characteristics, safety indicators and clinical efficacy of this device. Relative disadvantages of this non-repositionable valve could be generally overcome due to its distinctive features allowing precise planning, adequate navigation and accurate implantation.
This article presents a clinical case of successful transcatheter aortic valve implantation in an elderly patient with critical aortic stenosis at the stage of systolic dysfunction with development of genuine cardiogenic shock. The role of transcatheter aortic valve implantation in the pathogenetic treatment of acute heart failure due to decompensated aortic stenosis was briefly discussed.
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