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Management of Degenerative Aortic Bioprosthetic : First case TAVI valve-in-valve in Indonesia

Author : A.T. Faizal, D. Firman, D.A. Juzar, A.M. Soesanto, N. Haryono, A.A. Alkatiri, S. Soerinata
Upload Date : 19-04-2018

Introduction: Transcatheter Aortic Valve Implantation (TAVI) valve-in-valve procedures have been identified as a viable and non-invasive treatment option for patients with degenerative bioprosthetics valve, and current ESC guidelines recommend this approach in intermediate and high risk patients for surgical procedures. TAVI valve-in-valve procedure has been associated with a high success rate (95%) and from the PARTNER 2 Valve-in-Valve registry reported 30-day low mortality rate of 2.7%.

Objective : The aim of this case presentation is to report first case of TAVI valve-in-valve in Indonesia for patient with degenerative bioprosthetic valve

Case Ilustration: a 72-year-old man with a shortness of breath during activity with aortic regurgitation due to aortic prosthetic valve degeneration, performed TAVI valve-in-valve with complications of mild paravalvular leak and decrease of Hb due to gastrointestinal bleeding, patient receive 200cc blood transfusion, the patient is then discharged after hospitalize for 5 days.

Discussion: re-do operation has been assosiated with increased morbidity and mortality. Operation mortality associated with recurrent aortic valve surgery has ranged between 4.7% and 21.9%. recent study compared TAVI with re-do operation to treat bioprosthetic failure. Although patients undergoing TAVI were older and had high-risk profiles, there was no difference in 30-day mortality among the groups (4.2% and 5.1%). Re-surgery was associated with more life-threatening bleeding rates, acute renal failure, and permanent pacemaker implantation, while the residual transvalvular gradient was significantly higher in patients undergoing TAVI.

Conclusion: Currently the TAVI procedure could be an alternative of surgical procedure in patients with intermediate to high risk for operation as recommended by ESC on the management of valvular heart disease. Careful assessment through cardiovascular imaging is necessary to ensure successful of procedure and reduce complications.

KEYWORDS : Degenerative Bioprosthetic Valve, TAVI, paravalvular leakageDegenerative Bioprosthetic Valve, TAVI, paravalvular leakage


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