Has revolutionized the treatment of aortic stenosis in the elderly, time, may change the clinical history even in young patients: the implant of the aortic valve without surgery via percutaneous (Tavi) may become an option for all patients with aortic stenosis amenable to the implantation of a valve in organic, according to experts gathered on the occasion of the 80 th national Congress of the Italian Society of cardiology (Sic) in Rome.
The more recent studies have begun to investigate the use of Tavi in younger patients, and low operative risk, demonstrating effectiveness and a 50% reduction in the risk of stroke; also the probability of death and new admissions decreases, it also shortens the time for the post-operative recovery compared to surgery standard. The data that according to the cardiologists could increase to 70% the use of this intervention, more “soft” for the replacement of the aortic valve, which sooner or later may become necessary for the million italians who suffer from aortic stenosis, affects 10% of people over 65 and is the valve disease, the most widespread, which leads to the necessity of implantation of the valve in approximately 250,000 patients (2% of the elderly population). The selection of the correct treatment strategy must always be made, as always, in the individual patient.The data that according to the cardiologists could increase to 70% the use of this intervention, more “soft” for the replacement of the aortic valve, which sooner or later may become necessary for the million italians who suffer from aortic stenosis, affects 10% of people over 65 and is the valve disease, the most widespread, which leads to the necessity of implantation of the valve in approximately 250,000 patients (2% of the elderly population). The selection of the correct treatment strategy must always be made, as always in the individual patient.
“Until now,” explains Ciro Indolfi, president of the SIC – impiantavamo heart valves percutaneously only in old patients or patients with many diseases, with an operative risk was high for these patients, TAVI has been a real lifesaver, because there were no other safe and secure options to intervene in the case of aortic stenosis. The new data available – continued – suggest that TAVI offers the same results as traditional surgery, even in younger patients and low-risk operative, and proved to be even better in terms of the incidence of death, stroke, re-hospitalization at one year: the risk of stroke, for example, is reduced to 50%. This means that we will be able to avoid heart surgery to thousands of young patients: a very good news, because there is a prevention or a drug therapy for aortic stenosis, and unfortunately this is an increasing disease”.
In traditional surgery, the patient’s chest is opened, the heart stopped, and then replaced the aortic valve: the intervention lasts for hours, is performed under general anesthesia and extracorporeal circulation, requires a hospital stay and a rehabilitation long. With the Tavi instead, the only incision is a small hole in the groin, where it is inserted into the catheter that reaches the heart to bring the new valve and the tools needed to perform the intervention, lasting less than an hour in all.
“The Tavi represents the greatest technological innovation of Cardiology after coronary stents – adds Indolfi – and the new data that are accumulating, especially the randomized controlled trials published in the New England of Medicine and presented at the last American College of Cardiology have shown a great effective even in low-risk patients. It is a true revolution of the cardiology modern”.
The recovery post-Tavi is rapid, the discharge is carried out in three or four days. The new data imply that in the future it will be increasingly possible to choose the interventional procedure with a careful selection of patients remains, however, indispensable. “Like all new technologies – says Francesco Romeo, president of the Foundation, the Heart of us, the initial cost of Tavi is high, but it is expected in the immediate future, as happened with the coronary stents, a significant reduction in the cost of the materials. Furthermore, the data available to date show a good functionality of these valves in time, not inferior to those of the biological surgical”. “Certainly – continues Romeo – these data widen the indications for the use of Tavi, which in our Country, on the contrary is still little used: you make only 77 plants per million people, a number lower than the european average, and far less than that of Germany, where they are carried out a number of triple and Switzerland, where the number of Tavi is double compared to Italy”.
Good news for women who have to be subjected to the intervention of percutaneous implantation of the aortic valve. “In fact, for the first time in the interventional heart all of the published studies demonstrate that the implantation of Tavi goes better in the female sex, says Carmen Spaccarotella, cardiologa, interventionist at the university hospital of Catanzaro, in spite of the women have smaller arteries. These results are opposite to those obtained in the implantation of coronary stents, where the best results are obtained in the male sex. Then the women with aortic stenosis can be treated with this new minimally invasive technique”.
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