Type:
Educational Exhibit
Keywords:
Prostheses, Cardiac Assist Devices, Diagnostic procedure, CT-Angiography, CT, Interventional vascular, Cardiovascular system, Cardiac
Authors:
F. L. Serafini, D. Gabrielli, T. Salvatore, A. L. Caterino, A. R. Cotroneo; Chieti/IT
DOI:
10.26044/ecr2019/C-3139
Background
Patients with severe symptomatic aortic stenosis,
mostly when associated with left ventricular dysfunction,
are subjects with impairment of quality of life and reduced overall survival if not treated in the short term [1].
In these patients,
the most widespread and proven elective treatment,
capable to positively modify prognosis and life expectancy,
is the prosthetic aortic valve replacement (biological or mechanical) with cardiac surgery.
However,
the surgical approach,
considered at low-risk mortality in most of the population,
may represent a non-viable therapeutic option in those patients affected by important surgery contraindications (advanced age,
NYHA functional class,
left ventricular dysfunction grade,
biological sex,
the coexistence of coronary heart disease or previous myocardial revascularization).
Nowadays,
a new therapeutic non-surgical option for patients considered "inoperable" is available: Transcatheter Aortic Valve Implantation (TAVI),
also called Transcatheter Aortic Valve Replacement (TAVR) [2].
Performed under local anesthesia and sedation with cardio-anesthesiological supervision,
sternotomy and extracorporeal circulation are no longer fundamental thanks to common transfemoral percutaneous arterial access (in the majority of cases); if both common femoral arteries are affected by severe atherosclerosis,
small diameter and/or anatomical tortuosity,
alternative vascular accesses are also provided: trans-axillary,
trans-aortic,
trans-apical,
trans-carotid,
trans-septal and trans-caval access [3].
The choice and correct implantation of the prosthesis requires,
as a preliminary step,
adequate pre-procedural planning where the radiological diagnostic phase has a mandatory role through CT angiography.