Transcatheter Aortic Valve Implantation: A Report on Serbia's First Systematic Program

Darko Boljevic; Milovan Bojic; Mihajlo Farkic; Dragan Sagic; Dragan Topic; Vladimir Kovacevic; Jovana Lakcevic; Stefan Veljkovic; Milan Dobric; Sasa Hinic; Nenad Ilijevski; Marko Nikolic; Aleksandra Kaludjerovic; Matjaz Bunc; Aleksandra Nikolic

doi:10.3389/fcvm.2022.882854

Transcatheter Aortic Valve Implantation: A Report on Serbia's First Systematic Program

Front Cardiovasc Med. 2022 May 24:9:882854. doi: 10.3389/fcvm.2022.882854. eCollection 2022.

Authors

Darko Boljevic¹, Milovan Bojic^{1

2}, Mihajlo Farkic¹, Dragan Sagic^{1

3}, Dragan Topic¹, Vladimir Kovacevic¹, Jovana Lakcevic¹, Stefan Veljkovic¹, Milan Dobric^{1

3}, Sasa Hinic¹, Nenad Ilijevski^{1

3}, Marko Nikolic¹, Aleksandra Kaludjerovic¹, Matjaz Bunc⁴, Aleksandra Nikolic^{1

3}

Affiliations

¹ Dedinje Cardiovascular Institute, Belgrade, Serbia.
² School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
³ School of Medicine, University of Belgrade, Belgrade, Serbia.
⁴ University Clinical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia.

Abstract

Introduction: Severe aortic stenosis, a highly-common valve disease in the elderly, has a poor prognosis if left untreated. To address the concern of effective procedures for severe aortic stenosis, a systematic TAVI program was established at the Dedinje Cardiovascular Institute (Belgrade, Serbia).

Methods: Our cohort was composed of 56 patients (74±15 years old). The mean logistic EuroScore was 10.17%; the mean Society of Thoracic Surgeons score was 3.22%. One third of the patients were categorized as class III or IV of the New York Heart Association (NYHA). The valves selected for use were either self-expandable or balloon expandable (Evolut R, Medtronic; Acurate Neo, Boston Scientific and Myval, Meril). The choice of valve type was made by the Institute's Structural Heart Team, in accordance with the patient's native aortic valve, size and calcification of ilio-femoral vessels, as well as the need for alternative access. TAVI procedure was conducted according to current guidelines provided by the European Society of Cardiology.

Results: The procedure success rate was 100%. Trans-femoral approach was achieved in 100% of patients; percutaneously in 87.5%, while a surgical cut was necessary in 12.5%. No patient showed moderate or severe aortic regurgitation after the procedure, although trace or mild regurgitation was recorded in 30.3%. Permanent pacemaker was implanted in one patient (1.78%), contrast induced acute kidney injury occured in one patient (1.78%), no stroke was recorded, and three pseudo-aneurysms which required surgical intervention occurred. Three patients required blood transfusions (5.33%). A 30-day all-cause mortality rate was 1.78%.

Conclusion: The Dedinje Cardiovascular Institute spearheaded all efforts to establish a TAVI program in Serbia. Our initial TAVI results are promising, encouraging, and comparable with the results of previous large randomized trials. This initial experience opens the door for further development with a goal of our Institute to become a high-volume TAVI center.

Keywords: TAVI; TAVI in Serbia; aortic stenosis; aortic valve; structural heart disease interventions.