What an intensivist should know about TAVI
Aortic stenosis is the most common acquired valve disease. Whileit becomes tight and symptomatic, mortality at 2 years is close to 80% in the absence of treatment. The treatment requires valve replacement, historically performed surgically. The development of percutaneous procedures by Trans-catheter Aortic Valve Implantation (TAVI) made it possible to treat patients previouslyconsidered inoperable. With the increase in understanding, this procedure was extended to populations at high and intermediate surgical risk, and was even validated in low-risk patients in the United States. The principle consists in implanting an aortic bioprosthesis, sutured on a stent, directly on the existing valve, either by a balloon dilatation process or by a self-expanding process. TAVI has the advantage of a minimally invasive procedure, most often performed under local anesthesia and sedation, and a short length of stay. Functional recovery is faster than after cardiac surgery. Another advantage over conventional cardiac surgery is a lower rate of serious complications (cardiogenic shock, major bleeding, stroke, kidney failure, all-cause death). On the other hand, some complications are more specific to TAVI, such as the appearance of a high degree conductive disorder requiring the implantation of a pacemaker, and the existence of vascular complications. The resulting intensive care monitoring is therefore shorter than after surgery and should probably be customized according to the patient's risk.
The use of TAVI in at-risk and/or elderly subjects seems to be well established in France. The extension of indications to low-risk and younger subjects is not yet authorized in France and Europe. The study of the durability of percutaneously implanted bioprostheses in the long term requires further investigation.