Those over 75, those at high risk, those who cannot undergo the classic surgery by the heart surgeon. In light of the new guidelines of the European Society of Cardiology (ESC), spaces are opened for transcatheter aortic valve implantation procedures in case of stenosis. To suspect this valve alteration there are three warning symptoms, difficulty breathing, fainting and chest pain. The cardiologist, simply by auscultating the patient’s chest, can hypothesize the presence of the valve defect and then proceed to an echocardiogram, which can confirm the diagnosis.
The choice of the intervention
Then we think about the intervention to correct the problem, be it cardiac surgery or less invasive, with attention to the quality of life even at a distance as well as life expectancy, to evaluate the choice. There are no general recipes, so be careful: the Tavi (as this last strategy is technically defined), must be indicated case by case by specialists, when obviously the conditions of the excessively “narrow” aortic valve require treatment. What matters is to be followed in the best possible way with the patient being taken care of by a center that can foresee the commitment of various specialists. A “Heart Team” must therefore be present, made up of clinical cardiologists, interventional cardiologists, cardiac surgeons, cardiac imaging specialists, cardiovascular anesthetists and nurses, with the aim of evaluating both clinical and anatomical factors and, from now, also preferences of patients.
Heart door
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“The Heart Team represents the fundamental central” operational nucleus “that can direct the patient towards the best standard of care, according to the specific physical and clinical conditions of each one. It is a real team effort in which decisions are made. shared with a multidisciplinary approach “- he explains Francesco Musumeci, Past President of the Italian Society of Cardiac Surgery (Sicch). “Another fundamental aspect is the context in which the patient must be treated: regardless of the chosen approach – surgical or minimally invasive – this must take place within a Heart Valve Center”.
The arrival of the Tavi
Current treatment approaches involve surgery or minimally invasive percutaneous interventional procedures, such as Transcatheter Aortic Valve Implantation (Tavi), depending on the patient’s condition. “Tavi is a procedure. which allows the treatment of patients at high surgical risk or inoperable. In Italy the use of this approach is not generalized. From 2014 to 2019, the adoption of the transcatheter approach has increased in Italy from 2,586 to 8,255 total procedures. But there are significant territorial disparities linked to the regional fragmentation of the National Health System. In fact, from regions such as Lombardy, Veneto, Campania – with respectively 22%, 11.3% and 10.5% of the procedures carried out in 2020 – to regions where the application is still around less than 5%.
Don’t underestimate the situation
The important thing, in any case, is to address the situation that mainly affects the elderly. And do not underestimate the situation, not only on the basis of the numbers (there would be about 60,000 patients with aortic stenosis each year who would need treatment, but sometimes the picture is not recognized) but also on the basis of the “weight” of a disease that it can be very serious. This is why an information campaign that involves Gise (Italian Society of Interventional Cardiology) in collaboration with Sic (Italian Society of Cardiology) e Sicch (Italian Society of Cardiac Surgery).
It is not a benign disease
“Untreated aortic stenosis is not a benign disease, given that about 50% of patients with the severe symptomatic form die within two years of starting symptoms – he comments. Ciro Indolfi, president of the Italian Society of Cardiology – cardiology has revolutionized the therapy of this pathology, which previously could only be treated surgically, introducing the Tavi, thanks to which today thousands of patients in Italy are successfully treated. The new indications of the European Society of Cardiology update some parameters for the choice of the most appropriate treatment, increasing the level of recommendation for the procedure, which becomes the first option in patients over 75. Below this age threshold, cardiac surgery is mainly used. if the surgical risk is low, otherwise the approach with Tavi can be favored “.
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