Trans-catheter aortic valve implantation for non-classical indications.
BACKGROUND
Trans-catheter aortic valve implantation (TAVI) has emerged as a novel therapeutic approach for patients with severe tricuspid aortic stenosis (AS) not suitable for aortic valve replacement.


OBJECTIVE
To describe our initial single-center experience with TAVI in patients with "off-label" indications.


METHODS
Between August 2008 and December 2011 we performed TAVI in 186 patients using trans-femoral, transaxillary, trans-apical and trans-aortic approaches. In 11 patients (5.9%) TAVL was undertaken due to: a) pure severe aortic regurgitation (AR) (n = 2), b) prosthetic aortic valve (AV) failure (n = 5), c) bicuspid AV stenosis (n = 2), and d) prosthetic valve severe mitral regurgitation (MR) (n = 2).


RESULTS
Implantation was successful in all: six patients received a CoreValve and five patients an Edwards-Sapien valve. In-hospital mortality was 0%. Valve hemodynamics and function were excellent in all patients except for one who received an Edwards-Sapien that was inside a Mitroflow prosthetic AV and led to consistently high trans-aortic gradients. No significant residual regurgitation in AR and MR cases was observed.


CONCLUSIONS
TAVI is a good alternative to surgical AV replacement in high risk or inoperable patients with severe AS. TAVI for non-classical indications such as pure AR, bicuspid AV, and failed prosthetic aortic and mitral valves is feasible and safe and may be considered in selected patients.
Leviev Heart Center, Sheba Medical Center, Tel Hashomer,, Israel. amit.segev@sheba.health.gov.il
Amit
A
Segev
Dan
D
Spiegelstein
Paul
P
Fefer
Amichai
A
Shinfeld
Ilan
I
Hay
Ehud
E
Raanani
Victor
V
Guetta
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome