Transcatheter Aortic Valve Implantation: Experience of Sainte Clotilde Hospital in Reunion Island

Introduction: Degenerative aortic stenosis is the most common valvulopathy in developed countries. The implantation of a percutaneous aortic valve (TAVI) has taken an important place in the management of this valvulopathy. The objective of this work is to report the results of patients treated by TAVI by the team of Sainte Clotilde Hospital (Reunion Island). Patients and Methods: This was a descriptive retrospective study conducted from 01/10/2014 to 01/10/ 2017 in the Sainte Clotilde Hospital, Reunion Island. All patients who received TAVI for degenerative aortic stenosis were included in the study. Follow-up was completed until 31/08/19. Results: Forty-six (46) patients were included (sex ratio 0.53). The age was 82 (±7.5). Respectively, 56.5%, 21.7% and 6.5% of patients were diabetic [n = 26 (56.5%)], severe renal impairment [n = 10 (21.7%)] and hemodialysis [n = 3 (6.5%)]. All procedures were performed by femoral route under consious sedation. Edwards’ prostheses were used more often (93%), 100% Sapien 3, 6% of which were size 23. The primary success rate was 97.8% and the failure rate was 2% (deaths per procedure). The TAVI range of 0.66 ± 0.14 and 46.8 ± 15.5 against 1.48 ± 4.3 and 13.8 ± 5 in post TAVI. Severe pulmonary arterial hypertension (>60 mmHg) was observed in 21.7% of pre-TAVI patients compared to 4% in post TAVI patients. The overall rate of complications was 17% (n = 8). They were related to conductive disorders [6.5% (n = 3)], paraprosthetic leakage [2% (n = 1)], tamponade [2% (n = 1)], and hemorrhagic complications [6.5% (n = 3)]. Mean follow-up was 946 days (median = 1007.5 days), mean follow-up death rate was 30.4% (n = 14). The causes of death were non-cardiac in 57% (n = 8) of the cases. Conclusion: The TAVI results of the Sainte Clotilde Hospital Clinic are comparable to those observed in the literature. How to cite this paper: Ali, A.A., Pouillot, C. and Rambaud, G. (2019) Transcatheter Aortic Valve Implantation: Experience of Sainte Clotilde Hospital in Reunion Island. World Journal of Cardiovascular Diseases, 9, 772-780. https://doi.org/10.4236/wjcd.2019.910069 Received: August 29, 2019 Accepted: October 28, 2019 Published: October 31, 2019 Copyright © 2019 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Aortic stenosis (AS) is the most common primary valvulopathy leading to surgical or percutaneous surgery in Europe and North America. Its prevalence increases with the aging of the population [1]. It is a degenerative disease characterized by progressive calcification of the aortic valve (Mönckeberg's disease). In the calcified AS of the elderly, the aortic valve becomes restrictive, the area of the aortic ejection tract decreases and the diastolic pressure of the left ventricle increases [2]. The TAVI was developed in the early 2000s, following the work of Alain Cribier's team, a Cardiology department in Rouen, France. As a result, this technique has progressed rapidly to become the treatment of choice for severe aortic stenosis in high-risk or inoperable patients [3]. In recent years, we have seen an increase in the number of TAVI and the broadening of the spectrum of their medical indications [4]. The implantation of TAVI in patients at low to intermediate risk is one of the major transitions observed in recent years [5]. The first TAVI was performed in Reunion in October 2014 by the team of Dr. Christophe Pouillot of the Sainte Clotilde Hospital (SCH). The objective of this work is to report the results and the follow up of the patients who received TAVI by the SCH team (50th center in France TAVI).

Patients and Method
This is a retrospective, descriptive study carried out from 01/10/2014 to 01/10/ 2017 at SCH. Every patient who got a TAVI during this period was included in the study. The selection of our patients was based on the European Society of Cardiology recommendations [1]. They were recruited through the consultation or were sent to us by our correspondent cardiologists city.
The pre-TAVI assessment included: echocardiography, coronary angiography, supra-aortic trunk ultrasonography, thoracoabdominopelvicangioscan, respiratory function test, and dental care. The TAVI indications were validated by a multidisciplinary staff (heart team).
The interventions took place in the hybrid room of the Reunion University Hospital in presence of anesthesiologists and cardiac surgeons.
The TAVI was performed according to the following technique: after puncturing the femoral artery under local anesthesia (xylocaine) and sedation (by neuroleptic), the biological valve mounted on a stent was introduced and then moved foward to the aortic valve. The stent was then deployed in the aortic valve using a balloon (expendable balloon) or dropped to self-deploy. Once the procedure was completed, a cardiac ultrasound was performed to check the functionality of the bioprosthesis and to look for any complications. Then the patient The following variables were studied: -Characteristics of the population: sex, age, size, comorbiditties (diabetes, chronic renal failure and hemodialysis).
Severe PAH was defined by systolic pulmonary arterial pressure > 60 mmHg. Statistical analysis Quantitative variables were presented by their mean and standard deviation, and qualitative variables by their percentage. The analysis of the efficacy of TAVI was done by comparing pre-and post-test ultrasound data with a student test for continuous variables and a chi-square test for qualitative variables.

Results
During the period of our study, forty-six (46) patients were included: 16 men (35%) and 30 women (65%). The mean age was 82 ± 7.5 years, the sex ratio was 0.53 and the average EuroScore logistic risk score was 28.9 ± 18.7. The most common indication for TAVI was high-risk surgery (69.5%). Table 1 presents the epidemiological and clinical characteristics of the 46 patients. In pre-TAVI, the average ultrasound LVEF was 56.5%, the mean AVA was 0.66 ± 0.14 cm 2 , the MTAG was 46.8 ± 15.5 mmHg, there was a severe PAH was in 21.7% of cases.
Technical caracteristic of the TAVI procedure: All procedures were performed by femoral route under local anesthesia and neuroleptic sedation. The Edwards Sapien 3 bio prosthesis was more often used (93%), with 63 % Sapien 3 No. 23. The primary success rate was 97.8%. The average hospital stay was nine (9) days. Table 2 shows the technical characteristics of the TAVI procedure.    Table 3 compares the pre-and post-TAVI echocardiographic data.
The complication rate was 17% (n = 8), mainly atrioventricular blocks 6.5% (n = 3) and local bleeding at the puncture site 6.5% (n = 3). The mean follow-up was 946 days (median = 1007.5 days), mean follow-up death rate was 30.4% (n = 14), of which 11% (n = 5) died in the first year after TAVI. The causes of death were non-cardiac in 57% (n = 8) of cases, cardiac in 29% (n = 4) of cases and not known in 14% (n = 2) of cases. The different types of complications related to TAVI and causes of death outside the hospital period are summarized in Table 4.

Discussion
The AS evolves slowly until the first symptoms appear. The functional surface of  pressures. The mortality is 50% at 2 years in untreated patients from the onset of the first symptoms [6]. Survival declines when AS becomes very tight [7] [8].
Mean survival is less than 12 months after the first episode of cardiac decompensation. The combination of stage III or IV dyspnea, left ventricular dysfunction and mitral insufficiency further aggravates mortality with a 3-year survival of less than 20% [9]. Echocardiography is a key examination, it can confirm the diagnosis and search for associated valvulopathies.
TAVI has taken an important place in the management of calcified AS of the elderly in France and worldwide [10] thanks to the improvement of the technique (decrease of the device size (14F), improvement of the prostheses), improved operator experience (lack of systematic predilatation, better sizing of prostheses by measuring aortic CT diameter), and excellent results in patients contraindicated for surgery, at high risk, or at intermediate risk [11] [12] [13].

Limitations of Our Study
The main limitation of this study is the small sample size.

Conclusion
The TAVI experience of SCH is positive with a high success rate, a low complication rate, and acceptable mid-term mortality.

Conflicts of Interest
The authors do not declare any conflict of interest.