In running a structural heart program, we are frequently asked to take on exceptional clinical challenges, often for which there has been no (or very little) precedent.
Sydney Heart Team principal, Professor Michael Vallely, describes how to establish a TAVI program in the attached paper.
Within the spectrum of high-risk patients with aortic stenosis, some patients are of exceptional risk. They often have very weak hearts that predispose them to prohibitive risks of mortality when undergoing TAVI.
While most keyhole (transcatheter or percutaneous) aortic valve implant procedures are done through an artery in the groin (femoral artery), a significant number of patients have narrowed arteries in the leg or arteries that are too small, thereby precluding this approach.
This patient is a 72-year-old woman who was profoundly short of breath. She couldn’t walk more than 10 metres without becoming exhausted and had to sleep upright at night, if she could sleep at all.
This is a patient case about an 81-year-old man with a severely narrowed aortic valve, or what we call the aortic stenosis, which is severe narrowing of the heart valve that takes all the blood out of the heart.
Sometimes we’re asked to do extraordinary or unprecedented things, and the case of Chris, a young 30-year-old man who was born with a complex congenital heart disease, is a good example.
Joseph is a 92-year-old man who was critically unwell. He had two completely blocked arteries to the heart that could not be treated by keyhole technique (angioplasty). He also had a severely narrowed aortic valve and needed a new aortic valve.
In an elderly high-risk population with aortic stenosis, our TAVI program reports a 30-day and 17-month mortality of 3% and 8%, respectively. These clinical outcomes are remarkable when compared with international benchmarks.