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Transcatheter aortic valve implantation in end-stage renal disease.

Hamilton P, Coverdale A, Edwards C, Ormiston J, Stewart J, Webster M, de Zoysa J - Clin Kidney J (2012)

Bottom Line: However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality.Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS).The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, North Shore Hospital, Auckland, New Zealand.

ABSTRACT
Valvular heart disease is common in patients with end-stage renal disease and, if symptomatic, may lead to valve replacement surgery. However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS). Here we describe two patients on haemodialysis who underwent TAVI with satisfactory outcomes. The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

No MeSH data available.


Related in: MedlinePlus

TAVI in ESRD. Shown in (A) is the CoreValve percutaneous aortic prosthesis with leaflets fashioned from porcine pericardium hand sewn into a nickel titanium (nitinol) self-expanding frame. The valve is crimped down and loaded into a sheath in (B). The delivery system is placed across the stenosed valve in (C) (the white arrow indicating the end of the delivery sheath). In (D), the sheath is partially retracted (white arrow), allowing partial expansion of the nitinol frame (black arrows). In (E), the sheath has been fully retracted allowing full-frame expansion and valve deployment. (F) Depicts the Edwards Sapien valve fashioned from bovine pericardium, hand sewn onto the stainless steel balloon-expandable frame. (G) Depicts the valve mounted on the delivery balloon, which in (H) lies across the diseased valve. Balloon inflation expands the valve, (I). (J) After balloon removal, shows a competent aortic prosthesis.
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fig1: TAVI in ESRD. Shown in (A) is the CoreValve percutaneous aortic prosthesis with leaflets fashioned from porcine pericardium hand sewn into a nickel titanium (nitinol) self-expanding frame. The valve is crimped down and loaded into a sheath in (B). The delivery system is placed across the stenosed valve in (C) (the white arrow indicating the end of the delivery sheath). In (D), the sheath is partially retracted (white arrow), allowing partial expansion of the nitinol frame (black arrows). In (E), the sheath has been fully retracted allowing full-frame expansion and valve deployment. (F) Depicts the Edwards Sapien valve fashioned from bovine pericardium, hand sewn onto the stainless steel balloon-expandable frame. (G) Depicts the valve mounted on the delivery balloon, which in (H) lies across the diseased valve. Balloon inflation expands the valve, (I). (J) After balloon removal, shows a competent aortic prosthesis.

Mentions: TAVI is an emerging technology that allows implantation of a prosthetic valve without the need for a median sternotomy or cardiopulmonary bypass (Figure 1). It is currently employed in patients with symptomatic AS in whom comorbidities or technical issues make the patient inoperable or at high risk for surgical valve replacement. The early experience reported a technical success of 75% and 30-day mortality of 22% [20]. Improved patient selection, increased operator experience and newer implantable valves of lower profile with better delivery systems have all contributed to steadily improving outcomes. Recent registries report technical success in over 98% and 30-day survival in over 87% of patients [21, 22, 23]. Accepted indications and contraindications for TAVI have now evolved [24]. TAVI is associated with an improvement in aortic valve area, aortic valve gradient, quality of life, functional capacity and 6-min walk distance [25].


Transcatheter aortic valve implantation in end-stage renal disease.

Hamilton P, Coverdale A, Edwards C, Ormiston J, Stewart J, Webster M, de Zoysa J - Clin Kidney J (2012)

TAVI in ESRD. Shown in (A) is the CoreValve percutaneous aortic prosthesis with leaflets fashioned from porcine pericardium hand sewn into a nickel titanium (nitinol) self-expanding frame. The valve is crimped down and loaded into a sheath in (B). The delivery system is placed across the stenosed valve in (C) (the white arrow indicating the end of the delivery sheath). In (D), the sheath is partially retracted (white arrow), allowing partial expansion of the nitinol frame (black arrows). In (E), the sheath has been fully retracted allowing full-frame expansion and valve deployment. (F) Depicts the Edwards Sapien valve fashioned from bovine pericardium, hand sewn onto the stainless steel balloon-expandable frame. (G) Depicts the valve mounted on the delivery balloon, which in (H) lies across the diseased valve. Balloon inflation expands the valve, (I). (J) After balloon removal, shows a competent aortic prosthesis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400512&req=5

fig1: TAVI in ESRD. Shown in (A) is the CoreValve percutaneous aortic prosthesis with leaflets fashioned from porcine pericardium hand sewn into a nickel titanium (nitinol) self-expanding frame. The valve is crimped down and loaded into a sheath in (B). The delivery system is placed across the stenosed valve in (C) (the white arrow indicating the end of the delivery sheath). In (D), the sheath is partially retracted (white arrow), allowing partial expansion of the nitinol frame (black arrows). In (E), the sheath has been fully retracted allowing full-frame expansion and valve deployment. (F) Depicts the Edwards Sapien valve fashioned from bovine pericardium, hand sewn onto the stainless steel balloon-expandable frame. (G) Depicts the valve mounted on the delivery balloon, which in (H) lies across the diseased valve. Balloon inflation expands the valve, (I). (J) After balloon removal, shows a competent aortic prosthesis.
Mentions: TAVI is an emerging technology that allows implantation of a prosthetic valve without the need for a median sternotomy or cardiopulmonary bypass (Figure 1). It is currently employed in patients with symptomatic AS in whom comorbidities or technical issues make the patient inoperable or at high risk for surgical valve replacement. The early experience reported a technical success of 75% and 30-day mortality of 22% [20]. Improved patient selection, increased operator experience and newer implantable valves of lower profile with better delivery systems have all contributed to steadily improving outcomes. Recent registries report technical success in over 98% and 30-day survival in over 87% of patients [21, 22, 23]. Accepted indications and contraindications for TAVI have now evolved [24]. TAVI is associated with an improvement in aortic valve area, aortic valve gradient, quality of life, functional capacity and 6-min walk distance [25].

Bottom Line: However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality.Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS).The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, North Shore Hospital, Auckland, New Zealand.

ABSTRACT
Valvular heart disease is common in patients with end-stage renal disease and, if symptomatic, may lead to valve replacement surgery. However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS). Here we describe two patients on haemodialysis who underwent TAVI with satisfactory outcomes. The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

No MeSH data available.


Related in: MedlinePlus