*6.1.3 Rapid deployment prostheses*

Their use in association with MIS approaches, providing a reduction in surgical aggression in addition to the reduction in ECC and aortic clamping time. These designs have the common feature of being expandable, anchoring themselves to the aortic ring in a similar way to the devices used in TAVI. To date, there are two commercially available models: Perceval (LivaNova) and Intuity (Edwards Lifesciences). Those prostheses differ from each other in a few characteristics.


**39**

*Current Management of Severe Aortic Stenosis in Intermediate Risk Patients*

with lower mortality, lower morbidity, and less invasiveness [43].

peripheral arterial disease through imaging studies such as CT.

allows the aortic clamping and extracorporeal circulation times to be reduced. Reports of early outcomes have shown an important reduction in aortic crossclamp and cardiopulmonary bypass (CPB) [38, 39]. These findings were confirmed in both the European TRITON [40] and the US TRANSFORM trials [41]. Even more important, these times were reduced significantly in combined

TAVI was developed as an alternative to AVR in the very or extremely high-risk patient population, and its first implantation in man was performed by Cribier [42] in 2002. Since then, there has been a nonstop development of less invasive strategies

TAVI is currently carried out using two main approaches, **transfemoral** and **transapical**. If this is not feasible, then the other two main approaches could be used namely trans-axillary artery or transaortic approaches. It is, therefore, highly recommended to perform an adequate preoperative assessment of the degree of

The results of the PARTNER I Cohort A trial also have important implications. The primary endpoint of the trial was met, with TAVI found not to be inferior to aortic valve replacement for all-cause mortality at 1 year. Death at 30 days was lower than expected in both arms of the trial: TAVI mortality (3.4%) was the lowest reported in any series, despite an early generation device and limited previous operator experience. Aortic valve replacement mortality (6.5%) was lower than the expected operative mortality (11.8%). On 2015, the 5-year follow-up result of the PARTNER I trial was published [44]; they screened 3105 patients, of whom 699 were enrolled (348 assigned to TAVR, 351 assigned to SAVR). At 5 years, risk of death was 67·8% in the TAVR group compared with 62.4% in the SAVR group (hazard ratio 1.04, 95% CI 0.86–1.24; p = 0.76). They recorded no structural valve deterioration requiring surgical valve replacement in either group. Moderate or severe aortic regurgitation occurred in 40 (14%) of 280 patients in the TAVR group and two (1%) of 228 in the SAVR group (p < 0.0001), and was associated with the increased 5-year risk of mortality in

**7. Intermediate risk patients: who are they? And how do we have to** 

As we described before, currently AHA/ACC guideline for the management of patients with valvular heart disease [7, 19] defines the intermediate-risk patients as those who has an **STS 4**–**8%** with no more than mild frailty or one major organ system compromise not to be improved postoperatively and minimal procedurespecific impediments. In the other hand, the European guidelines define such patient as at "increased surgical risk" (STS or EuroSCORE II >4% or logistic

EuroSCORE I > 10% or other risk factors not included in these scores such as frailty,

porcelain aorta, and sequelae of chest radiation) [8].

*DOI: http://dx.doi.org/10.5772/intechopen.83422*

cardiac procedures [38].

*6.1.4.1 Implantation techniques*

*6.1.4.2 TAVI results*

the TAVR group [44].

**manage them?**

*6.1.4 Transcatheter aortic valve implantation (TAVI)*

allows the aortic clamping and extracorporeal circulation times to be reduced. Reports of early outcomes have shown an important reduction in aortic crossclamp and cardiopulmonary bypass (CPB) [38, 39]. These findings were confirmed in both the European TRITON [40] and the US TRANSFORM trials [41]. Even more important, these times were reduced significantly in combined cardiac procedures [38].
