P300 AORN A. CARDARELLI NAPOLI/ FEDERICO II UNIVERSITY INTERHOSPITAL PROTOCOL: TAVI IN A COMPLEX SCENARIO

Abstract

Abstract Rational: In order to provide the best treatment for patients affected by severe aortic stenosis at intermediate–high surgical risk, since more than 3 years an interhospital protocol beetween the Cardiology, UTIC and Cath–lab department of AORN A. Cardarelli of Naples, a center without cardiac surgery, and the cath–lab of the department of Cardiovascular Emergencies, Clinical Medicine and Ageing Medicine of AOU Federico II, is active. The agreement provides the carrying out of a TAVI procedures for patients hospitalized at the A. Cardarelli, by transfering them with a resuscitation ambulance to the Federico II cath–lab, and subsequent return to the department of origin after the execution of the interventional procedure. Case report: 85 year old lady with hypertension, moderate–severe chronic respiratory failure and atrial fibrillation treated with NOAC, is admitted in the emergency room for acute pulmonary edema and contextual diagnosis of severe aortic stenosis is made. After clinical stabilization, the TAVI program is started: both an angio–CT scan and a coronary angiography are carried out, with the detection of a critical calcified stenosis involving left main branch and proximal LAD and a chronic occlusion of Cx branch. Multidisciplinary evaluation and collegial evaluation with the colleagues from the Federico II University are carried out, and indication is given to TAVI with contextual PTCA of LM and LAD critical stenosis. A joint procedure of PTCA with 2 DES and TAVI with Evolute R 29 valve is then carried out in a single session at the Federico II University of Naples and after post–procedural observation, the patient is transferred back to the UTIC of A. Cardarelli for hospitalization. During the hospital stay, no procedural complications are reported and the patient is discharged 4 days after in good clinical conditions; a triple therapy with NOAC and DAPT is started, continuing it for 1 month with subsequent suspension of ASA and carrying on therapy with NOAC + Clopidogrel. At 1 and 6 months clinical follow–up, the patient is stable and well compensated, without significant clinical complications and with NYHA class 2. Conclusions The results of these years–experience, highlight the feasibility and safety of this strategy, making it possible to plan and carry out TAVI procedures even in centers that do not have onsite cardiac surgery, considering the growing indications for TAVI and the subsequent increase of patients who need this procedure