Transcatheter Aortic Valve Implantation: Review of Current Evidence

2013 ◽  
pp. 3-17
Author(s):  
Philippe Généreux ◽  
Martin B. Leon
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Current Evidence ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Need for Embolic Protection During Transcatheter Aortic Valve Implantation: An Interventionalist’s Perspective on Histopathology Findings

2017 ◽  
Vol 12 (01) ◽  
pp. 36 ◽  
Author(s):  
Herbert G Kroon ◽  
Nicolas MDA Van Mieghem ◽  
◽  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Current Evidence ◽  
Embolic Protection ◽  
Transcatheter Aortic Valve ◽  
Replacement Technique ◽  
Protection Devices ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is a less invasive aortic valve replacement technique and is indicated for patients with symptomatic severe aortic stenosis and a high operative risk. Cerebral embolisation seems inherent to TAVI, as illustrated by the consistent appearance of new brain lesions on post-procedural MRI studies. Embolic protection devices may capture or deflect embolised material en route to the brain and thus reduce TAVI-related brain injury. Histopathology studies of captured debris revealed a diverse aetiology including recent or organised thrombotic material, tissue originating from the aortic valve, atherosclerotic plaques or myocardium and foreign body components. In this overview we provide a perspective on current evidence and implications for embolic protection devices in the dynamic TAVI field.

scholarly journals Alternative Access for Transcatheter Aortic Valve Implantation: Current Evidence and Future Directions

2019 ◽  
Vol 2 (1) ◽  
pp. 23-27 ◽  
Author(s):  
JJ Coughlan ◽  
Thomas J Kiernan ◽  
Samer Arnous
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Clinical Investigation ◽  
Severe Aortic Stenosis ◽  
Current Evidence ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Randomised Controlled ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the usual technique for patients with severe aortic stenosis who are at high risk for surgical aortic valve replacement. The transfemoral (TF) route is the most commonly used access type, and significant progress in this procedure has greatly increased the proportion of patients who can undergo it. Not all patients are suitable for TF TAVI, however, so other routes, including transapical, transaortic, subclavian, trans-subclavian/transaxillary, transcarotid and transcaval, may need to be used. Evidence on these routes shows promising results but the majority of this is registry data rather than randomised controlled trials, so TF TAVI remains the safest access route and should be considered for most patients. However, in patients who are unsuitable for TF TAVI, alternative access routes are safe and feasible. The challenges concern choosing the best route, the valve to use and skill of the specialist centre. This article provides a overview of options for alternative vascular access in TAVI, the clinical rationale for using them, current evidence and areas for clinical investigation.

Transcatheter aortic valve implantation in low-risk patients: A case of rational over exuberance. The time is not now

2021 ◽  
pp. 021849232110185
Author(s):  
Manoraj Navaratnarajah ◽  
Suvitesh Luthra ◽  
Sunil Ohri
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Low Risk ◽  
Current Evidence ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background Review of evidence and concerns, relating to extension of transcatheter aortic valve implantation usage to low–risk patients. Methods Comprehensive literature review was conducted identifying articles relating to transcatheter aortic valve implantation. Results Transcatheter aortic valve implantation is effective in patients with aortic stenosis. Currently, long-term durability and cost-effectiveness are unproven, anticoagulation requirement undefined, permanent pacemaker implantation and paravalvular leak rates higher than following surgical aortic valve replacement. Conclusions Current evidence supporting transcatheter aortic valve implantation usage in low-risk patients is insufficient. Extending use now, to this large young patient population is premature, and should be delayed.

scholarly journals Intraventricular Conduction Disturbances After Transcatheter Aortic Valve Implantation

2020 ◽  
Vol 15 ◽  
Author(s):  
Shu-I Lin ◽  
Mizuki Miura ◽  
Ana Paula Tagliari ◽  
Ying-Hsiang Lee ◽  
Shinichi Shirai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Current Trend ◽  
Pacemaker Implantation ◽  
Current Evidence ◽  
Intraventricular Conduction ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Despite significant improvements in transcatheter aortic valve implantation (TAVI) outcomes, periprocedural conduction disturbances, such as new-onset left bundle branch block (LBBB) and new pacemaker implantation (PMI), remain relatively frequent concerns. The development of periprocedural conduction disturbances can be explained by the proximity between the aortic valve and the conduction system. Although prior studies reported heterogeneity in PMI rates after TAVI, current evidence supports the potentially deleterious consequence of LBBB and PMI, and several predisposing factors have been reported. Therefore, new strategies to avoid conduction disturbances and to improve their management are required, particularly with the current trend to expand TAVI to a low-risk population.

Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Pathology: Current Evidence and Technical Challenges

2021 ◽  
Vol 39 ◽  
Author(s):  
Andreas Schaefer ◽  
◽  
Lenard Conradi ◽  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Current Evidence ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Technical Challenges ◽  
Valve Pathology ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an established therapy for severe symptomatic aortic valve stenosis (AS) in patients at high and intermediate risk for surgical aortic valve replacement (SAVR). Current evidence also suggests at least non-inferiority of TAVI in low-risk patients compared to SAVR. However, there are special subsets of patients and anatomical circumstances in which TAVI is traditionally considered a suboptimal treatment strategy due to procedure inherent increased risks (e.g., rupture of cardiac chambers in patients with severe calcifications of the left ventricular outflow tract, valve migration in very large aortic annuli). One of these special subsets is bicuspid AS. Bicuspid aortic valve disease is the most common congenital heart defect and most frequent reason for AS in patients <70 years of age. Bicuspid aortic valve pathology is characterized by special anatomical complexities like asymmetrical cusp proportion and calcium distribution, a more pronounced annular ellipticity compared to tricuspid aortic valves and concomitant dilation of the thoracic aorta. These factors have led physicians to traditionally indicate TAVI more reluctantly in those patients in the past. In this article, current evidence for TAVI for bicuspid AS is discussed and technical challenges are highlighted.

scholarly journals New Challenging Scenarios in Transcatheter Aortic Valve Implantation: Valve-in-valve, Bicuspid and Native Aortic Regurgitation

2021 ◽  
Vol 16 ◽  
Author(s):  
Sandra Santos-Martínez ◽  
Ignacio J Amat-Santos
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Current Evidence ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is the most frequently performed structural technique in the field of interventional cardiology. Initially, this procedure was only used in patients with severe symptomatic aortic stenosis and prohibitive risk. Now, barely one decade after its introduction, TAVI indications extend to low- and intermediate-risk patients. Despite these advances, several challenging scenarios are still on the periphery of the evidence base for TAVI. These include valve-in-valve procedures, lower-risk patients with bicuspid aortic valve and the treatment of pure aortic regurgitation. Whereas the valve-in-valve indication has expanded rapidly, evidence for the use of TAVI compared with conventional surgery for bicuspid aortic valve is limited, including the best choice of device should TAVI be used. Evidence for TAVI in pure aortic regurgitation is still anecdotal because of suboptimal outcomes. Operators worldwide have described variations in the TAVI procedural technique to achieve commissural alignment and to minimise the rate of pacemaker use through cusp overlap implantation. In light of the potential clinical benefits, this may also be an area of further development. This review aims to discuss the current evidence available supporting the use of TAVI for these new indications.

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