Лучшие больницы для «Aortic Stenosis Treatment» в ОАЭ

Aortic stenosis (AS) is the pathological obstruction of left ventricular outflow caused by progressive thickening, calcification, and fusion of the aortic valve leaflets, most commonly degenerative (senile calcific) in origin, though rheumatic and congenital bicuspid aortic valve disease remain significant aetiologies in South Asian and Middle Eastern populations. As the valve orifice narrows — severe AS is defined as an aortic valve area (AVA) ≤1.0 cm², a mean pressure gradient ≥40 mmHg, or a peak aortic jet velocity ≥4.0 m/s on Doppler echocardiography — the left ventricle compensates through concentric hypertrophy, eventually leading to diastolic dysfunction, reduced coronary flow reserve, and, in end-stage disease, systolic failure. The classical clinical triad of angina, syncope, and heart failure (Heyde's syndrome being a notable associated finding) marks the inflection point at which annual mortality without intervention approaches 25–50%.

• ELIGIBILITY — SYMPTOMATIC SEVERE AS: Patients with AVA ≤1.0 cm² (indexed AVA ≤0.6 cm²/m²) AND at least one of: angina on exertion, unexplained syncope or pre-syncope, or NYHA Class II–IV dyspnoea attributable to AS
• ASYMPTOMATIC SEVERE AS WITH HIGH-RISK FEATURES: LVEF <50%, very severe AS (Vmax ≥5 m/s or mean gradient ≥60 mmHg), rapid haemodynamic progression (increase in Vmax ≥0.3 m/s/year), or an abnormal exercise stress test
• MODERATE AS WITH CONCURRENT CARDIAC SURGERY: Patients requiring CABG or other open cardiac surgery who have moderate AS (AVA 1.0–1.5 cm²)
• REQUIRED PRE-PROCEDURAL DIAGNOSTICS:

- Transthoracic Echocardiography (TTE): Primary valve assessment; AVA by continuity equation, gradients, LVEF, and annulus sizing

- Transesophageal Echocardiography (TEE): Annular measurement, leaflet morphology, bicuspid vs. tricuspid classification

TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR / TAVI) — MINIMALLY INVASIVE GOLD STANDARD FOR INTERMEDIATE-TO-HIGH RISK:

TAVR has rapidly expanded from a salvage procedure for inoperable patients (PARTNER 1B, 2011) to the preferred approach for intermediate-risk (PARTNER 2A, SURTAVI) and, increasingly, low-risk patients (PARTNER 3, Evolut Low Risk, 2019). A bioprosthetic valve — crimped onto a delivery catheter — is deployed within the native diseased leaflets, which are pushed aside (not excised). The procedure is performed under fluoroscopic and echocardiographic (TEE or ICE) guidance. Access routes include:

• Transfemoral (TF-TAVR): Preferred route (~90% of cases); 14–16Fr sheath through the femoral artery; performed under conscious sedation or general anaesthesia; hospital stay 2–4 days; fastest recovery
• Alternative Access (when TF unavailable): Transapical (TA), Transaortic (TAo), Transsubclavian/Transaxillary, or Transcaval (TC) — each requiring cardiac surgery support

Approved TAVR platforms available at GAF partner centres:

PHASE 1 — PRE-ARRIVAL & REMOTE CONSULTATION (Weeks 1–3 before travel):

• Patient submits medical records (echocardiogram reports, cardiac catheterisation, CT scans, blood work) to GAF Healthcare's medical coordination team
• GAF's partner cardiologist/cardiac surgeon conducts a teleconsultation and performs preliminary risk stratification using STS-PROM and EuroSCORE II
• Heart Team decision: TAVR vs. SAVR vs. combined procedure recommended in writing
• GAF issues a formal Invitation Letter for e-Medical Visa (India) or assists with UAE medical visit visa
• Provisional procedure date confirmed; pre-admission instructions issued (medications to hold — antiplatelet agents, anticoagulants, metformin; NPO guidelines)

PHASE 2 — ARRIVAL & PRE-OPERATIVE WORKUP (Days 1–3 in country):