부산대학교 도서관

Purpose: Transcatheter aortic valve implantation (TAVI) is an emerging technique in the treatment of symptomatic patients with severe aortic stenosis and contraindications to surgery. Transthoracic echocardiography plays an essential role for the proper selection of candidates for TAVI. Echocardiographic follow-up is also essential for determining performance of the prosthesis and hemodynamic changes over time. We report our echocardiographic experience of the early 30 patients who underwent successful transcatheter aortic valve implantation at three years of follow-up.Methods: From July 2007 to March 2011, 184 patients (76 male, mean age 81 ± 5 years) with contraindications to surgery ( mean logistic Euro-score 22 ± 14) who underwent TAVI, were evaluated by clinical and echocardiography follow-up at 24 hours, 1 month, six months, one, two and three years after the procedure. Left ventricular function, transaortic pressure gradient, aortic valve area and aortic regurgitation were assessed.Results: Median echocardiographic follow-up was 32 ± 3 months. Procedural success was of 95.7%. We reported one intra-procedural death (0.7%). Pre-procedural aortic valve area was 0.59 ± 0.2 cm, transaortic peak pressure gradient and mean pressure gradient averaged 89 ± 26 mmHg and 56 ± 26 mmHg respectively. Ejection fraction was 52% ± 10%. At 3 years of follow-up survival was 71%. After the procedure, 91% of patients had an improvement in NYHA functional class, aortic valve area significantly increased and both peak and mean transaortic pressure gradients decreased (P <.0001 and P <.0001, respectively). Improvement was stable at follow-up. At 1- and 3- years follow-ups, patients showed no severe degree of aortic regurgitation. Paraprosthetic leaks were detected in 98% of cases, but only two of these resulted in significant paravalvular AR. Post-procedural paraprosthetic regurgitation was trivial or mild in severity in 68%, moderate in 30% and severe in 2% of cases. No residual regurgitation worsened during 3-years follow-up, in contrast AR reduced of one degree in 9.7% of cases at the follow-up. This reduction occurred mainly after six months-1 year from TAVI.Conclusions: Transcatheter aortic valve implantation shows good long term durability. Echocardiography at three years demonstrates correct prosthesis positioning and function after percutaneous aortic implantation. The procedure can offer an adequate solution in selected patients with aortic stenosis.