Transcatheter aortic valve implantation in elderly patients with severe aortic stenosis and rheumatic phenotype

• Published in: Cardiovascular intervention and therapeutics Vol. 40; no. 3; pp. 632 - 643
• Main Authors: Elkaialy, Ahmed Abdelrahman, Farag, Nabil, Mostafa, Ahmad Elsayed, Baraka, Mahmoud, Kamal, Diaa
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.07.2025
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Cardiology; Female; Follow-Up Studies; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Original; Original Article; Phenotype; Prospective Studies; Rheumatic Heart Disease - complications; Rheumatic Heart Disease - surgery; Severity of Illness Index; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; Rheumatic; Transcatheter aortic valve implantation; Aortic stenosis
• ISSN: 1868-4300; 1868-4297; 1868-4297
• DOI: 10.1007/s12928-025-01113-w

Significant fibrosis is characteristic of rheumatic aortic valve disease that affects anchoring and deployment of the trans-catheter heart valve. Our goal was to determine whether trans-catheter aortic valve implantation (TAVI) is an effective treatment option for severe aortic stenosis patients with rheumatic valvular disease. This study is a prospective cohort study that includes a total of 54 rheumatic severe aortic stenosis patients who were referred for TAVI. The age ranged from 65.00 to 83.00 years (mean age 72.75 ± 5.86 years). Notably, 63% of the patients had undergone preimplantation balloon dilatation. The outcomes included total new conduction disturbances (transient and permanent defects of atrio-ventricular block and left bundle branch block) in 31.4% of the patients, permanent pacemaker implantation in 3.7%, and valve embolization in 1.85%, and no patients had moderate to severe para-valvular leak. All-cause death within a 6-month follow-up was 3.7%. This cohort was then compared to a propensity score matched group of degenerative calcific severe aortic stenosis of 54 cases revealing comparable post-procedural results. Compared with the outcomes of TAVI in patients with degenerative aortic stenosis, TAVI represents a viable and durable option for rheumatic severe aortic stenosis patients. Graphical abstract