Rajat Datta1, Prashant Bharadwaj2, Naveen Aggarwal3, G Keshavamurthy4, Prafull Sharma5, Nitin Bajaj6, Vijay Bohra7, V S Guleria8, Balbir Singh9. 1. Director General Armed Forces Medical Services, O/o DGAFMS, Defence Offices Complex, A Block, Africa Avenue, New Delhi, India. 2. Director General Medical Services (Air), Air HQ, West Block 6, RK Puram, New Delhi, India. 3. Director (Cardiologist), Max Superspecialty Hospital, Phase 6, Mohali, Punjab, India. 4. Consultant (Cardiology), Army Hospital (R&R), Delhi Cantt, India. 5. Senior Advisor (Medicine) & Cardiologist, Military Hospital Jalandhar, India. 6. Senior Advisor (Medicine) & Cardiologist, Army Institute of Cardio Thoracic Sciences, Pune, India. 7. Classified Specialist (Medicine) & Cardiologist, Command Hospital (CC), Lucknow, India. 8. Classified Specialist (Medicine) & Cardiologist, Army Hospital (R&R), Delhi Cantt, India. 9. Classified Specialist (Medicine) & Cardiologist, 7 Air Force Hospital, Kanpur, India.
Abstract
Backrground: Transcatheter aortic valve replacement (TAVR) has become an accepted modality of treatment in intermediate and high surgical risk patients of symptomatic severe calcific aortic stenosis (AS). We herein report Indian data of 84 intermediate and high-risk patients who underwent TAVR at two Armed Forces cardiac centres. Methods: Most of the patients underwent TAVR in cardiac catheterization lab by percutaneous transfemoral approach, under conscious sedation. Patients were followed up and echocardiographic parameters were assessed after six months of procedure. Results: Total of 84 intermediate and high-risk patients underwent TAVR between Jan 2017 and June 2021. Mean age of population was 71.5 ± 8.4 years; 28.5% of patients had bicuspid aortic valve and Mean STS score was 6.34 ± 2.08. Majority (92.8%) patients underwent the procedure under conscious sedation. Self-expanding valves were used in 72.6% and balloon expandable in 27.4% of patients. Predilatation was done in 64% patients while 13% cases underwent post dilatation. Procedural mortality was 2.3%. Rate of permanent pacemaker implantation was 4.9%. Ischemic stroke occurred in 1.1% of patents. There was no case of severe paravalvular leak. Emergency surgical aortic valve replacement was done in 2.4% patients. Procedural success in this study was 97.6%. All-cause mortality was 9.5% at 6 months. Conclusions: TAVR is an effective treatment modality in intermediate and high-risk Indian patients with severe aortic stenosis. Patients with bicuspid or previous bio prosthetic aortic valves also have a good outcome post TAVR.
Backrground: Transcatheter aortic valve replacement (TAVR) has become an accepted modality of treatment in intermediate and high surgical risk patients of symptomatic severe calcific aortic stenosis (AS). We herein report Indian data of 84 intermediate and high-risk patients who underwent TAVR at two Armed Forces cardiac centres. Methods: Most of the patients underwent TAVR in cardiac catheterization lab by percutaneous transfemoral approach, under conscious sedation. Patients were followed up and echocardiographic parameters were assessed after six months of procedure. Results: Total of 84 intermediate and high-risk patients underwent TAVR between Jan 2017 and June 2021. Mean age of population was 71.5 ± 8.4 years; 28.5% of patients had bicuspid aortic valve and Mean STS score was 6.34 ± 2.08. Majority (92.8%) patients underwent the procedure under conscious sedation. Self-expanding valves were used in 72.6% and balloon expandable in 27.4% of patients. Predilatation was done in 64% patients while 13% cases underwent post dilatation. Procedural mortality was 2.3%. Rate of permanent pacemaker implantation was 4.9%. Ischemic stroke occurred in 1.1% of patents. There was no case of severe paravalvular leak. Emergency surgical aortic valve replacement was done in 2.4% patients. Procedural success in this study was 97.6%. All-cause mortality was 9.5% at 6 months. Conclusions: TAVR is an effective treatment modality in intermediate and high-risk Indian patients with severe aortic stenosis. Patients with bicuspid or previous bio prosthetic aortic valves also have a good outcome post TAVR.
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