New advances in the prevention of transcatheter aortic valve implantation failure: current and future perspectives

Abstract

valve degeneration (SVD), resulting in limited durability. The long-term suitability of TAVI is still a matter of debate and studies or registries reporting outcomes beyond 5-year follow-up 8-10 are scarce, hampering the assessment of real incidence of transcatheter valve failure. 11 All the above formed the basis for our review, in which we sought to evaluate the risk factors, mechanisms, and current and future advances capable of preventing TAVI failure. Definition of structural valve deterioration and bioprosthetic valve failure "Valve degeneration" and "valve failure" are different concepts worth to be defined. Structural valve degeneration is one of the most likely causes of bioprosthetic breakdown, but the etiopathogenesis of valve failure is not always valve dependent.

Patients scheduled for TAVI tend to form abnormal fibrin clots more resistant to lysis: the impact of age

“…Since such fibrin features cannot be markedly improved by antiplatelet therapy with inconsistent data on a beneficial effect of aspirin on fibrin variables [23], our study might support clinical data suggesting suboptimal thromboprotection in a subset of TAVI patients who receive dual antiplatelet therapy (DAPT) which is usually recommended for 3 or 6 months to prevent device-related thromboembolic complications [9]. Thromboembolic events after TAVI, mostly ischemic cerebrovascular episodes, occur in up to 7% of the patients within the first years of TAVI and are associated with considerable morbidity and mortality [24][25][26][27].…”

“…Subclinical leaflet thrombosis following TAVI may affect up to 11.5% of patients within months after the procedure, which increases the risk of stroke or transient ischemic attack [24,25,28]. OAC, including VKA or NOAC was showed to prevent and treat this complication [24,26], and OAC was demonstrated to favorably affect fibrin clot characteristics [29].…”

Comparison of the short-term safety and efficacy of transcarotid and transfemoral access routes for transcatheter aortic valve implantation

“…This trend is also confirmed by our results, which are shown in Table 2 and 3. Paravalvular regurgitation (PVL), like leaflet thrombosis, structural valve deterioration, prosthesis-patient mismatch, and endocarditis can lead to faster valve dysfunction [32]. Our analysis showed no correlation between the amount of PVL and the type of access route.…”

Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA): the first experience in Poland

“…We would like to underline that when performing BASILICA procedure one should be aware of possible complications, such as hemodynamic instability from leaflet laceration, nontarget Astato® wire traversal (most commonly left atrial entry), and embolic debris release [5].…”