New European guidelines on the Tavi procedure for the replacement of the malfunctioning aortic valve, a minimally invasive technique that avoids open heart surgery, and from which many more patients can now benefit. The recommendations of the European societies of cardiology (Esc) and cardiac surgery (Eacts), presented at the Congress of the Italian Society of Cardiology (Sic) which closed in Rome, in fact considerably broaden the audience of candidates for the transcatheter method.
Aortic stenosis is the most common and growing heart valve disease, experts recall. It is a chronic developmental pathology that progressively and rapidly leads to the development of syncope, angina and heart failure: from the onset of symptoms, the prognosis is on average 2-3 years in about 50% of patients, if not treated. In Italy about 200 thousand over 75 suffer from aortic stenosis, of which 150 thousand are severely affected. To treat this disease, it is possible to replace the defective valve with an operation that can be performed with an open heart or precisely via transcatheter with the Tavi.
“Tavi was the greatest innovation in interventional cardiology after coronary stents – says Ciro Indolfi, Sic president – Available since 2007, this technique was initially reserved for patients inoperable with the classic cardiac surgery or at too high risk in case of similar intervention. With the passing of the years and the refinement of the technique, the Tavi has been made available for patients at lower and lower risk “. Now, “in summary, European guidelines recommend Tavi for patients 75 years of age or older. Patients under 75 years of age can undergo Tavi when they have many comorbidities or are inoperable.”
Currently, explains Indolfi, “patients are evaluated and referred for surgery or transcatheter by a medical team made up of interventional cardiologists, cardiac surgeons, imaging experts and other specialists (heart team), based on a series of clinical parameters and For the first time – highlights the specialist – the latest ESC-Eacts joint guidelines indicate that the patient’s will also be involved and taken into consideration in the choice of the type of intervention to be performed “.
“Furthermore – adds the president of cardiologists – the new guidelines help us to make decisions regarding the procedure to be performed. The first thing to do is to ascertain the severity of the aortic stenosis. In some cases all the parameters are in agreement in defining a stenosis. severe aortic disease, but in others it is not so simple: in these cases the echocardiogram and CT scan assist us in the diagnosis. Another thing to carefully evaluate is the patient’s symptoms. If there are symptoms such as chest pain, difficulty in breathing or decompensation cardiac, the intervention must be carried out quickly “.