Transfemoral Transcatheter Aortic Valve Implementation at Hospital Without On-site Cardiac Surgery: Early Clinical Outcome in Patients With Prohibitive Surgical Risk.
Aortic Stenosis
About this trial
This is an interventional treatment trial for Aortic Stenosis
Eligibility Criteria
Inclusion Criteria: Senile degenerative aortic valve stenosis with echocardiography derived criteria: mean gradient > 40 mmHg or jet velocity > 4.0 m/s aortic valve area (AVA) of < 0.8 cm2 (or AVA index < 0.5 cm2/m2) Symptomatic due to aortic valve stenosis as demonstrated by NYHA Functional Class > = II Age >= 75 years old Patients with prohibitive risk established in the Heart Team and defined on the basis of the following clinica instrument criteria according with the Varc-2 consensus. High surgical risk (%, logES>20%, EuroSCORE II > 9 and STS score > 8%) Porcelain aorta (heavy circumferential calcification or severe atheromatous plaques that do not allow clamping. Hostile chest (abnormal chest wall anatomy due to severe kyphoscoliosis or other skeletal abnormalities, complications form to previous surgery, evidence of severe radiotion damege, history of multiple recurrent pleural effusions causing internal adhesions. Fragilty (slowness, weakness, exhaustion, wasting and malnutrition, poor endurance and inactivity, loss of independence, BMI < 20 Kg/m2 and or weight loss 5 kg/year, serum albumin < 3,5 g/dl, cognitive impairment or dementia) Severe liver disease/cirrosis Presence of a patent graft of an internal mammary artery crossing mildline and/or adherent to posterior table of sternum Severe pulmoary hypertension Severe right ventricular dysfunction Transfemoral access allowed Signature of informed consent Exclusion Criteria: Tavi in case of aortic valve bioprosthesis (TAVI valve-in valve) controindication to femoral access Bicuspid aortic valve Instrumental characteristics, evaluated by angioTC, associated with an increased risk of major complications: severe left ventricle outflow tract or sub annular calcification, condition associated with an increased risk of rupture of the valve ring, presence of complex aortic plaques correlated with the possibility of dissection, valvular ring-coronary ostia distance < 10 mm associated with a high probability of coronary obstruction, severe aortic root dilatation or out of range aortic annulus diameters for TAVI are not complatible for safe valve implatation.
Sites / Locations
- AUSL Romagna Morgagni - Pierantoni HospitalRecruiting
Arms of the Study
Arm 1
Experimental
TAVI procedure
Patients will be evaluated at baseline to access their eligibility for the procedure. The day of TAVI patients will be prepared for the procedures as the institution's standard practice for an invasive percutaneous endovascular procedure. During the pre hospital discharge period, patients will be monitored and will receive standard post-procedure care as judged appropriate by PI. At 30 days from the procedure a Fu visit will be made in order to access survival and adverse clinical events.