Transcatheter aortic valve implantation in end-stage renal disease

Abstract

Valvular heart disease is common in patients with end-stage renal disease and, if symptomatic, may lead to valve replacement surgery. However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS). Here we describe two patients on haemodialysis who underwent TAVI with satisfactory outcomes. The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

Keywords: aortic stenosis; end-stage renal disease; haemodialysis; transcatheter aortic valve implantation.

Fig. 1.

TAVI in ESRD. Shown in (A) is the CoreValve percutaneous aortic prosthesis with leaflets fashioned from porcine pericardium hand sewn into a nickel titanium (nitinol) self-expanding frame. The valve is crimped down and loaded into a sheath in (B). The delivery system is placed across the stenosed valve in (C) (the white arrow indicating the end of the delivery sheath). In (D), the sheath is partially retracted (white arrow), allowing partial expansion of the nitinol frame (black arrows). In (E), the sheath has been fully retracted allowing full-frame expansion and valve deployment. (F) Depicts the Edwards Sapien valve fashioned from bovine pericardium, hand sewn onto the stainless steel balloon-expandable frame. (G) Depicts the valve mounted on the delivery balloon, which in (H) lies across the diseased valve. Balloon inflation expands the valve, (I). (J) After balloon removal, shows a competent aortic prosthesis.