Trans-Catheter Aortic Valve Replacement (AVR) in Severe Aortic Stenosis: A 3-year Experience in Modarres Hospital (A Tertiary University Hospital, Tehran, Iran)

Abstract

Background: Aortic stenosis (AS) is a progressive disease with high mortality if untreated; however, many high-risk patients do not receive surgical aortic valve replacement (AVR) due to comorbidities. Transcatheter aortic valve implantation (TAVI) offers a less invasive therapeutic choice. Objectives: This study evaluated the outcomes of TAVI at the Shahid Modarres Educational and Therapeutic Center in Iran. Methods: In this cross-sectional study, 100 consecutive patients (77.82 ± 6.97 years) with severe symptomatic AS underwent TAVI using balloon-expandable valves under conscious sedation over 3 years. Pre-procedural assessments included echocardiography and computed tomography (CT) angiography. The procedure was performed via transfemoral access under fluoroscopic guidance. Outcomes assessed included procedural complications, mortality at 30 days and 6 months, and echocardiographic data pre- and post-procedure. Results: The TAVI was successful in 99% of patients. Procedural complications occurred in 12%, with a mortality rate of 1%. Post-procedure, the mean pressure gradient (MPG) was 9.75 ± 6.19 mmHg and the peak pressure gradient (PPG) was 19.25 ± 10.15 mmHg. Mortality at 30 days was 3%, increasing to 6% by 6 months, while 23% were hospitalized for any cause within 6 months. Notable correlations were found between gradient improvement (ΔMPG and ΔPPG) and factors such as aortic valve area (AVA) and left ventricular ejection fraction (LVEF). Conclusions: Initial experiences with TAVI at our center indicate it is a safe and effective treatment for high-risk patients with severe AS, with positive mid-term outcomes underscoring the need for careful patient selection and management.