Initial Experiences of Transcatheter Aortic Valve Implantation (TAVI) In Iran with Midterm Follow up

Background: Surgical Aortic Valve Replacement (SAVR) is the gold standard method
for treatment of symptomatic severe senile Aortic Valve Stenosis (AS). For inoperable
patients, due to severe co-morbidities, Transcatheter Aortic Valve Implantation (TAVI)
has been suggested as a new and safe alternative with significant follow up superiority
to medical treatment; recently, it was suggested for patients at intermediate risk, as well.
Since its introduction in 2002, TAVI has well developed in more than 40 countries.
Objectives: We made an attempt to transfer this technology to Tehran University for
the first time and then evaluated the feasibility and safety of this new technique with
midterm closed clinical and echocardiographic follow up.
Patients and Methods: Eight patients (5 males), with a mean age of 77 ± 6.7 years old
underwent transfemoral TAVI from 2010, as the first sequential patients in Tehran
University, by Balloon expandable bioprosthetic Edwards SAPIEN transcatheter heart
valve, under general anesthesia in hybrid operation room.
Results: There were 7 tricuspid valves and one bicuspid aortic valve (AV). All the
patients had symptomatic severe senile valvular AS with severe co-morbidities so that
the surgeons did not agree with open SAVR. Closed preprocedural, procedural, in
hospital, one and 6 months clinical and echocardiographic assessments and follow up
were done. Results: Procedural success rate was 100% with good implantation of the
valve. A decrease in the AV mean gradient (MG) from preprocedural mean AVMG 52.2
± 19.7 mm Hg to 9.8 ± 3.7 mm Hg was observed in the 6 month follow up. One patient
had procedural papillary muscle damage and moderate mitral regurgitation (MR),
which needed hemodynamic support. No in hospital mortality or major complications
were seen. In the follow up period, one patient had unexplained sudden death in sleep
3 weeks after the discharge. The other 7 patients had good 6 months of follow up with
improvement of Functional Class (FC) and Left Ventricle Ejection Fraction (LVEF) from
mean 43 ± 13.5 % preprocedural to 50.7 ± 7.8% within 6 months.
Conclusions: Inoperable symptomatic senile valvular AS could be treated safely with
TAVI. In- hospital results of the first sequential experience of TAVI in Tehran University
of Medical Sciences were successful. TAVI in bicuspid AS and concomitant MR patients
needs more caution in the procedure and follow up.