• Francesco Saia, Cinzia Marrozzini, Gianni Dall'Ara, Vincenzo Russo, Sofia Martìn-Suàrez, Carlo Savini, Paolo Ortolani, Tullio Palmerini, Nevio Taglieri, Barbara Bordoni, Emanuele Pilato, Roberto Di Bartolomeo, Angelo Branzi, and Antonio Marzocchi.
• Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy. francescosaia@hotmail.com
• J Cardiovasc Med (Hagerstown). 2010 Oct 1; 11 (10): 727-32.

ObjectiveWe sought to assess what proportion of patients with severe symptomatic aortic stenosis who are excluded from cardiac surgery are eligible for transcatheter aortic valve implantation (TAVI).MethodsBetween July 2007 and December 2008, 98 patients with severe symptomatic aortic stenosis judged inoperable were referred to our institution for percutaneous aortic balloon valvuloplasty (PABV). They entered a screening for TAVI with the CoreValve Revalving System or the Edwards-Sapien valve, comprising general clinical evaluation, echocardiogram, coronary angiography, angiography and angio-CT scan of thoracic aorta and ilio-femoral axes.ResultsMean patients' age was 82 +/- 7 years; the vast majority presented relevant comorbidities. Mortality risk predicted by the logistic European System for Cardiac Operative Risk Evaluation was on average 25.3 +/- 14.5%. Overall, 45 (45.9%) patients met the criteria for TAVI: 29.6% for percutaneous transfemoral access, 6.1% for trans-subclavian and 10.2% for transapical approaches. Reason for exclusion was severe noncardiac comorbidity in around half of the cases. PABV allowed re-classification of several patients with very poor left ejection fraction and severe mitral regurgitation. Among the 39 patients undergoing TAVI after the screening, in-hospital mortality was 3.7% for transfemoral and 0 for trans-subclavian and transapical approaches.ConclusionsTAVI represents a viable therapeutic option for elderly patients with severe symptomatic aortic stenosis who are not candidates for surgical aortic valve replacement. However, presently less than half of them actually fulfil the criteria for these procedures.

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