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Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia.

ABSTRACT: Transcatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients.Determine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia.Retrospective, analytical cross-sectional.Tertiary cardiac care center.All patients who underwent TAVI for severe AS between February 2013 and December 2016 were included. Clinical, imaging, and laboratory information at baseline and at one year follow-up were analyzed.Clinical and echocardiography out.comes at discharge, at 1-month, and at end of follow-up; one-year mortality, complications and clinical response to TAVI procedure.N=80, mean (SD) age 79.5 (10.6) years, with severe AS and high-surgical risk.Fifty-five (69.2%) patients received Core valves, and 25 (30.8%) received Edward valves. Peri-procedure mortality was 3.8% and 1-year post-operative mortality was 13.8%. Ten patients (12.5%) had life-threatening or major bleeding. Nineteen (23.8%) patients had vascular complications, which were mostly minor. Fourteen patients (17.5%) developed acute kidney injury and 86% of these patients recovered. Five patients (6.25%) had pericardial effusion. Two patients (2.5%) developed endocarditis and another 2 patients (2.5%) had cerebrovascular accidents. Five patients (6.25%) received pacemakers. Mean aortic valve gradient significantly reduced from a mean (SD) 47.6 (19) mm Hg to 10.7 (6.0) mm Hg (P less than .001). New York Heart Association functional class was significantly reduced (P less than .001).The TAVI experience at MCC is encouraging and comparable to international outcomes in terms of success, morbidity, and mortality rate.Retrospective, relatively small sample size. Rate of minor bleeding was overestimated.None.

SUBMITTER: Alatawi FO

PROVIDER: S-EPMC6074303 | biostudies-other | 2018 May-Jun

REPOSITORIES: biostudies-other

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Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia.

Alatawi Faisal Owdah FO Abuelatta Reda A RA AlAhmedi Ahmed B AB Alharbi Ibraheem H IH Alghamdi Saleh S SS Sakrana Amal A AA Alamodi Osama A OA Naeim Hesham A HA

Annals of Saudi medicine 20180501 3

<h4>Background</h4>Transcatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients.<h4>Objective</h4>Determine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia.<h4>Design</h4>Retrospective, analytical cross-sectional.<h4>Setting</h4>Tertiary cardiac care center.<h4>Patients and methods</h4>All patients who underwent TAVI for severe AS between February 201 ...[more]

PMID: 29848933

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Project description:ObjectiveTranscatheter aortic valve implantation (TAVI) procedures are increasing rapidly, but the durability of tissue valve and periprocedural complications are not satisfactory. Immune reaction to the galactose-α-1,3 galactose β-1,4-N-acetylglucosamine (α-Gal) and conventional processing protocols of cardiac xenografts lead to calcification. Next-generation TAVI needs to be made with α-Gal-free xenografts by multiple anticalcification therapies to avoid immune rejection and enhance durability, and three-dimensional (3D) printing technology to improve the procedural safety.MethodsPorcine pericardia were decellularized and immunologically modified with α-galactosidase. The pericardia were treated by space filler, crosslinked with glutaraldehyde in organic solvent, and detoxified. The sheep-specific nitinol (nickel-titanium memory alloy) wire backbone was made from a 3D-printed model for ovine aortic root. After it passed the fitting test, we manufactured a self-expandable stented valve with the porcine pericardia mounted on the customized nitinol wire-based stent. After in vitro circulation using customized silicone aortic root, we performed TAVI in 9 sheep and obtained hemodynamic, radiological, immunohistopathological, and biochemical results.ResultsThe valve functioned well, with excellent stent fitting and good coronary flow under in vitro circulation. Sheep were sequentially scheduled to be humanely killed until 238 days after TAVI. Echocardiography and cardiac catheterization demonstrated good hemodynamic status and function of the aortic valve. The xenografts were well preserved without α-Gal immune reaction or calcification based on the immunological, radiographic, microscopic, and biochemical examinations.ConclusionsWe proved preclinical safety and efficacy for next-generation α-Gal-free TAVI with multiple anticalcification therapies and 3D-printing technology. A future clinical study is warranted based on these promising preclinical results.

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Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia.

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Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia.

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