Vol. 40 | No. 1 | January-June 2012 Back

Open Access

Transcatheter Aortic Valve Implantation with Corevalve®: A New Mode of Therapy for Surgically High-Risk Patients with Severe or Critical Aortic Stenosis

Ma. Richelle Isidro-Foronda, Theresa Menor, Nelson C. Lee, Melissa Co-Sia, Aristides G. Panlilio, Dante Morales, Timothy C. Dy
Jun 2012 DOI 10.69944/pjc.d2b873881d

Abstract

INTRODUCTION: Aortic Stenosis (AS) is a common and life-threatening disease that presents with angina, heart failure, or syncope. Internationally, transcatheter aortic valve implantation (TAVI) has become accepted as a less invasive percutaneous alternative to surgical replacement for high-risk patients with severe or critical AS. 

OBJECTIVE: This paper presents the first TAVI case performed at The Heart Institute of the Chinese General Hospital and Medical Center, and reports the first valve-in-valve TAVI case in the Philippines. 

CASE: An 87-year old diabetic male patient presented with congestive heart failure and a history of coronary artery bypass grafting, chronic obstructive pulmonary disease, and chronic renal insufficiency. A 2-D echocardiogram (2DE) revealed severe AS with normal left ventricular function. Left heart catheterization confirmed severe AS and showed severe triple vessel coronary artery disease with continued patency of all bypass grafts. Surgical aortic valve replacement was recommended but deemed too high-risk. Ancillary studies revealed that the patient was a viable candidate for TAVI. A 29-mm Corevalve® was implanted, with subsequent moderate to severe paravalvular aortic regurgitation (AR). A second 29-mm Corevalve® was implanted within the first Corevalve®. The patient tolerated the procedure well with marked improvement in symptoms. A repeat 2DE showed normal functioning bioprosthetic valve with minimal AR. 

CONCLUSION: TAVI is an alternative mode of therapy in carefully selected surgically high-risk patients with severe or critical AS. Careful and thorough pre-procedural measurements are key for proper valve sizing. Post TAVI calculation of the aortic regurgitation index is important in determining the short- and long term success of the procedure.

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