Transcatheter aortic valve replacement—state of the art and a glimpse to the future: ‘the Tailored Approach’

Bedogni, Francesco; Frigiola, Alessandro; Ranucci, Marco; Brambilla, Nedy; Montone, Rocco Antonio; Agnifili, Mauro; Menicanti, Lorenzo; Testa, Luca

doi:10.1093/eurheartj/suw017

Cited by 3 publications

(2 citation statements)

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“…However, the timing of peri-procedural stroke is only infrequently reported and cannot be assessed in this analysis. Furthermore, data on optimal antiplatelet therapy is scarce and recommendations are based on opinions rather than on controlled randomized data 18 . The ACCF/AATS/SCAI/STS guidelines recommend dual antiplatelet treatment (DAPT) with aspirin and clopidogrel with no further recommendation on duration 19 .…”

Section: Discussionmentioning

confidence: 99%

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Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies

Winter

Bartko

Hofer

et al. 2020

Sci Rep

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Aim of the present analysis was to collect and pool all available data currently in the literature regarding outcomes and complications of all approved TAVR prosthesis and to assess the transition from first to next generation TAVR devices by directly comparing both in regard of procedure related complications. Transcatheter aortic valve replacement is a well established treatment modality in patients with severe aortic stenosis deemed to be inoperable or at unacceptable risk for open heart surgery. First generation prostheses were associated with a high rate of peri-procedural complications like paravalvular regurgitation, valve malpositioning, vascular complications and conduction disorders. Refinement of the available devices incorporate features to address the limitations of the first-generation devices. A PRISMA checklist-guided systematic review and meta-analysis of prospective observational studies, national and device specific registries or randomized clinical trials was conducted. Studies were identified by searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials and LILACs from January 2000 to October 2017. We extracted and pooled data on both mortality and complications from 273 studies for twelve different valves prostheses in a total of 68,193 patients. In second generation prostheses as compared to first generation devices, we observed a significant decrease in mortality (1.47 ± 1.73% vs. 5.41 ± 4.35%; p < 0.001), paravalvular regurgitation (1.75 ± 2.43vs. 12.39 ± 9.38, p < 0.001) and MACE. TAVR with contemporary next generation devices has led to an impressive improvement in TAVR safety driven by refined case selection, improved procedural techniques and increased site experience.

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Section: Discussionmentioning

confidence: 99%

“…Coronary occlusion is a rare complication of the TAVR procedure with reported mortality rates of up to 50% 4 , 18 , 26 . Our pooled analysis showed that using next generation devices this complication is significantly less frequent, which is potentially attributable to the increasing operator experience.…”

Section: Discussionmentioning

confidence: 99%