Efficacy and Feasibility of Trans-Catheter Aortic Valve Implantation in Managing Rheumatic Aortic Valve Stenosis

Abstract Background: Rheumatic aortic valve disease is character-ized by significant fibrosis, and calcification only appears at the end of the degenerative phase. Compared to degenerative aortic stenosis (AS), anatomical differences are linked to the technical impact on the anchoring and deployment of the transcatheter heart valve. Our objective is to ascertain whether transcatheter aortic valve implantation is a practical and efficient therapeutic option for patients with rheumatic valvular disease who have severe aortic stenosis. Aim of Study: To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods: The study included 100 ESRD pa-tients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR <15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, ar-rhythmias, valvular diseases, ischemic conditions, and LV sys-tolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valveto detect E/A ratio, continuous wave Doppler on tri-cuspid valve to calculate TR vmax, and tissue Doppler on later-al mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic pa-rameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then strat-ified according to their diastolic dysfunction grading. Results: A total of 54 patients with rheumatic severe aor-tic stenosis who were referred to our center for TAVI were in-cluded in the current prospective cohort study. The mean age was 72.75±5.86 years, with a range of 65.00 to 83.00 years. It is noteworthy that pre-implantation balloon dilatation was performed in 63% of the cases. 31.4% of all new conduction disturbances included both temporary and permanent AVB and LBBB defects. In 3.7% of the cases, permanent pacemaker im-plantation was necessary. While 25.9% of cases had trace or mild leakage, none had moderate to severe PVL. We had two cases with significant vascular complications and one case of valve embolization. Within a 6-month follow-up, the all-cause death rate was 3.7%. Conclusion: For patients with rheumatic severe aortic ste-nosis, TAVI is considered a practical, viable, and long-lasting option.