Future Directions. Transcatheter Aortic Valve Implantation for Low-risk Patients: Inevitable Evolution or a Step Too Far?

2019 ◽  
Vol 72 (8) ◽  
pp. 664-671
Author(s):  
Guy Witberg ◽  
Tiffany Patterson ◽  
Simon Redwood ◽  
Bernard Prendergast
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Low Risk ◽  
Future Directions ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation is still inappropriate in low-risk, young patients: a UK perspective

2021 ◽  
pp. 1-4
Author(s):  
Suvitesh Luthra ◽  
Sunil K Ohri
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Young Patients ◽  
Evidence Base ◽  
Low Risk ◽  
Transcatheter Aortic Valve ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The PARTNER 3 and Evolut LRT trials have provided the evidence base for transcatheter aortic valve implantation in low-risk patients. However, there are still issues with durability, long-term follow up and complications before their widespread use can be considered appropriate in this group.

Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients

2018 ◽  
Vol 13 (3) ◽  
pp. 153-162 ◽  
Author(s):  
Juan A. Siordia ◽  
Jackquelin M. Loera ◽  
Matt Scanlon ◽  
Jessie Evans ◽  
Peter A. Knight
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Low Risk ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Heart ◽  
2019 ◽  
Vol 105 (Suppl 2) ◽  
pp. s51-s56
Author(s):  
Miguel Sousa Uva
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Low Risk ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

Acute intraventricular migration of a transcatheter aortic prosthesis

2019 ◽  
Vol 27 (9) ◽  
pp. 764-766
Author(s):  
Federico Del Re ◽  
Clemente Pascarella ◽  
Stefano Pratali ◽  
Michele Celiento ◽  
Uberto Bortolotti
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Low Risk ◽  
Heart Team ◽  
Conventional Surgery ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

We describe a low-risk patient who underwent transcatheter aortic valve implantation after refusing conventional surgery. During the procedure, prosthesis migration into the left ventricle prompted emergency surgical aortic valve replacement. Transcatheter aortic valve implantation is currently indicated in high-risk patients with aortic stenosis; its role in intermediate-risk subjects remains controversial, while in low-risk patients, surgery is still the procedure of choice. Because of such severe unpredictable procedure-related complications, the management of low-risk patients refusing surgery may be difficult. Whether the heart team should also consider potential ethical and economic aspects remains to be defined.

scholarly journals The path of transcatheter aortic valve implantation: from compassionate to low-risk cases

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L140-L145
Author(s):  
Corrado Tamburino ◽  
Roberto Valvo ◽  
Enrico Crioscione ◽  
Claudia Reddavid ◽  
Andrea Picci ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Developed Countries ◽  
Low Risk ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Extreme Risk ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aortic stenosis (AS) is one of the most common valvular diseases in developed countries. Transcatheter aortic valve implantation (TAVI) has emerged as alternative to medical treatment or surgical aortic valve replacement (SAVR) in all symptomatic patients with severe AS. In 2002, Cribier performed the first human TAVI through a trans-septal approach in a 57-year-old man with severe AS. Since then, several trials have compared TAVI vs. SAVR over the years. Today, it is superior in terms of mortality to medical therapy in extreme-risk patients, non-inferior or superior to surgery in high-risk patients, and non-inferior to surgery and even superior when transfemoral access is possible in intermediate-risk patients. Interesting results emerged from the latest multicentre trials involving patients with severe AS who were at low risk for death from surgery, demonstrating that this therapy will be offered to younger people in the next future.

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.

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