Aortic Valve Implantation

Defects in the valves of a heart can lead to regurgitation, and stenosis. Common symptoms include angina, shortness of breaths and heart failure. These defects affect the heart functionality. As a result, artificial heart valves are used to replace these defective valves. One artificial heart valve is the St. Jude Bileaflet valve.

All TAVI procedures were performed in a hybrid catheterization laboratory by the team comprised of interventional cardiologist, cardiac surgeon or vascular surgeon, anesthesiologist, echocardiographer, nurses and technicians as previously described [15]. The general or local anaesthesia and sedation, without the use of cardiopulmonary bypass was applied. Procedures were performed under angiographic and echocardiographic guidance. Before the procedure, a temporary pacing lead was inserted into the right ventricle through a jugular or femoral vein. Arterial access was obtained by cannulation of the right or left common femoral artery, with postprocedural haemostatasis achieved by using vascular closure systems (StarClose or Proglide), or by direct

Aortic stenosis—aortic valve stenosis— is caused by a narrowing of the heart’s aortic valve which leads to obstruction of the outflow of the left ventricle. Aortic stenosis is uncommon in patients under the age of 50. The most common cause in adults within industrialized countries is due to aortic valve calcification. Compared to any other cardiac diseases stenosis of the aortic valve is associated with increased morbidity and mortality. Some of the more uncommon causes of this deadly disease include congenital heart disease, rheumatic fever, and radiation. Patients with increased age, increased low density lipoprotein (LDL), increased lipoprotein A, hypertension, and smoking history have a higher risk of developing a stenotic valve. Patients suffering from aortic stenosis often are asymptotic until more of the advanced symptoms develop. At this time, they may present the “classic triad symptoms,” which include (1) angina, (2) syncope, and (3) heart failure. There are also some broad symptoms such as fatigue, dyspnea (usually with exertion), swollen ankles, difficulty exercising, or palpitations. Physical examination provides valuable insight into the diagnosis of aortic stenosis. Findings on physical examination can be confirmed through non-invasive two-dimensional Doppler echocardiogram, which is the gold standard for aortic stenosis. However, other imaging modalities for diagnosis and treatment options of this debilitating disease will be discussed in this

T.S. is a 75-year-old male who has a history of coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, cerebrovascular accident, hypertension, myocardial infarction, renal failure, atrial fibrillation, dyslipidemia, and severe cervical spinal stenosis C4-5. He underwent many procedures in the past, including coronary artery bypass graft, implantation of IV dual chamber permanent pacemaker, exploratory laparotomy, and cardiac pacemaker in situ.

Vascular closure devices following cardiac catherization through the femoral artery have been gaining significant traction since its use in the mid-1990s. Compared to the previous gold standard of manual compression, VCDs allow for shortened time to ambulation, decreased duration of hospitalization post procedure, and increased patient comfort. The devices have also shown safeness comparable to manual compression. Despite the many advantages and variety of devices available, there are still complications to take into account. More common issues include device failure, bleeding, and hematoma. Less common but more serious complications include infection, ischemia, limb loss, and death.

Aortic Stenosis is recognised as the most prevalent form of valvular heart disease in the ageing population. Increasing life expectancy has resulted in a significant increase in the number of older patients being referred for consideration of an aortic valve replacement. Although surgical aortic valve replacement (AVR), or open heart surgery, remains the best type of treatment for symptomatic severe aortic stenosis, other treatment options include: Transcatheter Aortic Valve Implantation (TAVI); balloon aortic valvuloplasty (BAV); medical therapy. Transcatheter Aortic Valve Implantation, also referred to as Transcatheter Aortic Valve Replacement, is one of the least invasive types of aortic valve replacement surgeries. TAVi is important to

Aortic stenosis is the most common valvular heart disease of the developed world. About 7% of the population over age 65 suffer from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is known to be dismal without valve replacement. Even though American College of Cardiology recommends aortic valve replacement as a class I recommendation to treat symptomatic severe aortic stenosis, approximately a third of these patients over the age of 75 are still not referred for surgery. Typically, this is due to concern about prohibitive surgical risk due to patient frailty, co-morbidities, age, and severe left ventricular dysfunction. The advent of transcatheter aortic valve replacement (TAVR) in Europe raised the hope for an alternative, less invasive treatment for aortic stenosis in the United States. We present a review of the existing and emerging literature pertaining to TAVR, including the PARTNER (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve) and CoreValve trials. Although surgical valve replacement (SAVR) remains the modality of choice for patients with severe aortic stenosis and low to intermediate operative risk for now, TAVR has certainly become the preferred approach for high risk patients, and it may gain traction for low and intermediate

Valvular stenosis is the hardening of the valves in the heart: mitral, tricuspid, pulmonary, and/or aortic. Stenotic valves are either too thick, stiff, or are fused together causing it to not open or close all the way like it normally should. This causes a decrease in blood flow to the next chamber of the heart. If one or more valves become diseased, pooling of blood in a chamber will occur, or the blood will leak

Thus, in the current era, It is much more common to perform interventional cardiac catheterization rather than for

132); however, there is increasing interest in the use of transradial artery access (TRA) for coronary angiography and PCI. Several European countries and Asia use TRA as the primary mode of access (Mitchell et al., 2012), but TRA still accounts for only ten percent of the overall PCI procedures in the United States (Amoroso & Kiemeneij, 2010). A more recent report revealed one of six PCI’s in interventional practice was completed by the TRA approach (Feldman et al., 2013) which is suggestive of increasing adoption of TRA in the United States.

50 percent of patients with severe aortic stenosis wouldn’t serve the nominal two year life expectancy in respect to those with Aortic valve replacement[28]. Hence, emphasis on the study of aortic stenosis and its progression is of decisive significance [23].

Aortic stenosis is a progressive valvular lesion that causes impairment of cardiac responses to surgical and anesthesia stresses. With aortic stenosis, blood ejecting into aorta is obstructed and pressure overload in left ventricle is increased. The heart compensates by left ventricular concentric hypertrophy, which would decrease the compliance of left ventricle. The heart becomes relying on left atrial contraction for optimal filling. Arial fibrillation is particularly problematic for patients with aortic stenosis, may produce dramatic decrease in stroke volume. Thickened myocardium due to concentric hypertrophy increase myocardial oxygen consumption was well as impairs myocardial perfusion.

Dr. Nader Moazami, director of the Cardiac Transplantation and Ventricular Assist Device Therapy Program at the Cleveland Clinic, told FoxNews.com they are still many years away from a permanent artificial heart. “Although tremendous strides have been made, biocompatibility will always remain a challenge,” said Dr. Moazami. The longest anyone has lived with the most widely used device worldwide, the SynCardia temporary TAH, was nearly four years.

VICs are also the essential components of the intrinsic repair system of the valve and respond to local tissue stress. 5 The constant motion of the valve leaflets, and connective tissue deformations associated with that movement produce damage to which the VICs respond in order to maintain valvular integrity.6 This regenerative process appears to be vital to normal valvular, and the absence of VICs in current prosthetic heart valve models is a probable factor contributing to structural failure.

Tashiro et al (2013) at Mayo clinic reported on 236 severe aortic stenosis patients and 256 controls that underwent non cardiac surgery between 2000