Experience of transcatheter implantation of CoreValve aortic valve bioprostheses in Clinic of Advanced Medical Technologies named after Nikolay I. Pirogov

Abstract

Background. Every year the number of operations of transcatheter aortic valve implantation increases, and the number of centers performing this intervention increases too. In this article we present the results of the operation of transcatheter aortic valve implantation at the Clinic of Advanced Medical Technologies named after Nikolay I. Pirogov St. Petersburg State University.Material and Methods. From December 2015 to December 2018, the specialists of the Clinic implanted 46 self-expanding transcatheter aortic valves of 2 generations – CoreValve and CoreValve Evolute R. All patients were patients of high and extremely high surgical risk for severe aortic stenosis. The decision on the implementation of TAVI was taken collectively as part of the “Heart Team”.Results. Most operations were performed under general anesthesia with transfemoral access (89%). In 2 cases (4.3%) the conversion of transcatheter surgery into an open cardiac surgery was required due to the development of intraoperative complications. Hospital mortality was 6.5%, non-fatal complications were 21.7%. Now we have mid-term results of CoreValve valves implantation. The functional class of heart failure is estimated to be no higher than II (by NYHA), the observation period is from 6 months to 2.5 years, and the hemodynamic parameters of the valve are satisfactory. Medterm results from the use of CoreValve Evolute R are expected.Conclusion. The TAVI procedure in patients of high and extremely high surgical risk is an alternative to open operation, showing not-worse (non-inferiority) early and medium-term results. Treatment of patients with intraoperative aortic insufficiency of the 2nd degree requires further improvement. Further research is planned with a view to obtaining long-term TAVI results.

Influence of implantation of a novel domestic prosthetic aortic valve on the functional class of heart failure one year after surgery

“…Выявлены значимые предикторы сохранения клиники ХСН после замены АК -высокий средний градиент на протезе, площадь поверхности тела, исходно высокий ФК ХСН по NYHA [10]. В исследовании, посвященном коррекции порока АК путем процедуры его транскатетерной замены в среднесрочном периоде, отмечено снижение ФК ХСН по NYHA [11]. Оценка непосредственных результатов замены АК у пациентов со сниженной фракцией выброса показала, что к моменту выписки ФК ХСН по NYHA стал I-II, при исходном ФК III-IV [12].…”