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Nov 15

Revolution in the management of aortic valve stenosis

There is unmet clinical need of standardized and safe modality of  treatment for severe degenerative calcific aortic stenosis especially in the high risk  population  who are older, frail and have multiple co morbidities, Writes Vijay Kumar and group from Fortis Escorts Heart Institute in the forthcoming CSI update being released in 63rd CSI early next month.

Surgical AVR is the gold standard, and definitive treatment for aortic valve disease. It has extremely good long-term follow-up data that alleviates symptoms and has very good prognosis in successfully treated patients.

However, older patients, with their increasing prevalence of co -morbidities, are often denied AVR because of premonition of increased surgical risk.

The emergence of catheter-based technologies has challenged this long-standing paradigm, and the results from the trials to date have been quite optimistic. In fact, management of severe aortic stenosis has been revolutionized by the rapid development in area of percutaneous valve intervention.

Percutaneous interventional technique of implanting the prosthetic heart valve avoids the need for cardiopulmonary bypass, opening the chest and the risk of anesthesia .It is becoming an attractive potential treatment option for this population.

The current state of the art of TAVI  viz the valves available , methods of implantation, patient selection criterion, training and resources, creating A” Heart Team” building a Multidisciplinary (aortic) valve clinic, evaluating the high-risk patient and focus on complications associated with TAVI  all constitute a brief elaboration.

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