Management of patients with transcatheter implantable aortic valve

Abstract

Valvular heart disease remains one of the causes of cardiovascular morbidity and mortality worldwide. Aortic stenosis is the most common valvular pathology requiring cardiac surgery. For elderly and senile patients with high risks of volumetric cardiac surgery, a new type of biological prosthesis, a transcatheter implantable aortic valve, has become a solution to the problem. Over the past decade catheter interventions for severe valvular heart disease have evolved from balloon dilatation of native stenotic valves to replacement and reconstructive intervention of diseased valves. Transcatheter aortic valve implantation, which is widespread in the USA and Europe, has also begun to be performed in our country, primarily in comorbid groups of patients. Rapid technological advances in device design are likely to improve immediate and long-term outcomes of surgery and expand the current indications for transcatheter aortic valve implantation. The article analyzes the indications for the procedure in accordance with the latest recommendations of 2021, possible complications of the transcatheter aortic valve implantation, as well as the principles of patient management after the procedure, including the principles of drug therapy in this group of patients. Separately, the topic of aortic regurgitation and the possibility of transcatheter aortic valve implantation are touched upon, since this pathology is a new indication that has appeared only in the latest recommendations of the European Society of Cardiology. In this review, we want to acquaint physicians with the indications for transcatheter aortic valve implantation, the main complications, and the principles of managing patients in the perioperative period. The complication rate after transcatheter aortic valve implantation is decreasing due to technical advances and experience of interventional surgeons. In-depth knowledge of potential complications and their prevention plays a key role in improving the immediate and long-term results of surgery.