Transcatheter Aortic Valve Implantation in West Africa: A Severe Aortic Stenosis Case Report.

Abstract

Background and objectives: Aortic valve stenosis (AoS) is the most common valvular pathology in the elderly, many of whom are ineligible or high-risk for surgery due to comorbidities. Transcatheter Aortic Valve Implantation (TAVI) was developed as a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe AoS. Its efficacy was first demonstrated in the landmark PARTNER trial, which compared TAVI to medical therapy in ineligible SAVR patients. Subsequent studies have validated its use in intermediate and low-risk groups. Despite its growing adoption, there has yet to be a report of a successful TAVI procedure in West Africa.

Methods: The procedure involved transcatheter aortic valve implantation using radial and femoral arterial access. A 14Fr Python sheath was introduced after vessel dilation, and the valve was crimped and positioned in the aortic annulus under fluoroscopic guidance. Serial aortograms confirmed accurate placement, and haemostasis was achieved using a Proglide suture, protamine administration, and manual pressure. The patient was transferred to the ICU post-procedure for monitoring.

Results: The patient's post-procedure imaging showed a well-seated valve with trivial central aortic regurgitation, no paravalvular leak, and an insignificant gradient of 12.25 mmHg. The patient remained stable, resumed anticoagulation, and was discharged with a follow-up scheduled in one week.

Conclusions: This case report details the successful prosthetic aortic valve implantation in an 83-year-old high-risk surgical candidate with hypertension and bilateral knee replacements. It marks a significant step toward adopting less invasive valvular heart disease management approaches in the region.