Transcatheter aortic valve replacement in patients with degenerative calcified rheumatic aortic stenosis: A 10-patient case series

• Published in: International journal of cardiology 2019-04, Vol.280, p.38-42
• Main Authors: Saji, Mike, Highchi, Ryosuke, Iguchi, Nobuo, Shimuzu, Jun, Tobaru, Tetsuya, Takanashi, Shuichiro, Takayama, Morimasa, Isobe, Mitsuaki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve - surgery; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Calcified valve; Calcinosis - complications; Calcinosis - diagnostic imaging; Calcinosis - surgery; Computed tomography; Echocardiography - methods; Female; Humans; Male; Retrospective Studies; Rheumatic heart disease; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - diagnostic imaging; Rheumatic Heart Disease - surgery; TAVI; TAVR; Transcatheter Aortic Valve Replacement - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.11.090

Transcatheter aortic valve replacement (TAVR) for patients with rheumatic heart disease (RHD) has not been well-known. This study aimed to assess characteristics and computed tomography (CT) findings of the aortic valve in old patients with RHD and to investigate the safety and efficacy in the patients who underwent TAVR. Of 352 consecutive patients with severe aortic stenosis (AS) who underwent TAVR at the Sakakibara Heart Institute between 2013 and 2016, 10 patients (2.8%) were considered to have degenerative calcified rheumatic AS by transthoracic echocardiography. Young patients with rheumatic AS without any calcification were not indicated for TAVR in this study. They were likely to have previous pacemaker implantation, atrial fibrillation, anticoagulants, diuretics, reduced ejection fraction, mitral valve involvement, and high pulmonary artery pressure. CT was able to clearly visualize irregular valve thickening, commissure fusion, and a relatively small amount of calcification from the tip of the leaflet to the base of the aortic valve. Mortality at 30 days after TAVR was 0%, with a mean Society of Thoracic Surgeons Score of 7 ± 4%. Device success was 90%, and no patients met the safety endpoint at 30 days. CT was able to visualize the calcified aortic valve in old patients with RHD, and we demonstrate the safety and efficacy of TAVR in this specific population. Care should be taken for procedural success in particular characteristics with marginal calcified aortic valve, anticoagulant use with low body mass index, or concomitant mitral valve disease. •Rheumatic fever exposes during childhood and affects their valves for a long time.•It likely results in comorbidities including frailty which are high-risk factor for surgery.•TAVR for rheumatic heart disease is a good indication if the valve is calcified enough.•Precise CT assessment for degree of calcification is required for safe procedure.