Pros and cons of transcatheter aortic valve implantation (TAVI)

Abstract

Transcatheter aortic valve implantation (TAVI) or replacement (TAVR) was recently approved by the FDA for intermediate risk patients with severe aortic stenosis (AS). This technique was already worldwide adopted for inoperable and high-risk patients. Improved device technology, imaging analysis and operator expertise has reduced the initial worrisome higher complications rate associated with TAVR, making it comparable to surgical aortic valve replacement (SAVR). However, many answers need to be addressed before adoption in lower risk patients. This paper highlights the pros and cons of TAVI based mostly on randomized clinical trials involving the two device platforms approved in the United States. We focused our analysis on metrics that will play a key role in expanding TAVR indication in healthier individuals. We review the significance and gave a perspective on paravalvular leak (PVL), valve performance, valve durability, leaflet thrombosis, stroke and pacemaker requirement.

Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion

“…Secondly, we looked at the consequences of calcification on PVR. It is well accepted that the presence of extensive calcification in the landing zone precludes complete prosthesis expansion and its precise apposition to the native valve and LVOT (17,(21)(22)(23)(24)(25)(26). Delgado et al was one of the first groups that used multi-detector computer tomography (MDCT) to demonstrate an association between the degree of calcification and PVR in TAVI patients (26).…”

“…The severity of calcification of the non-coronary leaflet (NCL) was associated with significant PVR immediately after TAVI using the first generation self-expanding Medtronic Corevalve TM (Medtronic Inc., Minneapolis, MN, USA) (16). NCL calcification is also an independent predictor of PPI post TAVI using the balloon expandable SAPIEN 3 TM valve (Edwards Lifesciences, Irvine, CA, USA) (17) . The aim of this study was to further add to this knowledge base by assessing the feasibility of measuring the spatial distribution of aortic valve leaflet calcification in a large cohort of patients undergoing TAVI using the Medtronic Evolut R TM valve system, and to analyse the impact on the frequency and severity of PVR and PPI.…”

Temporal trends and outcomes in utilisation of transcatheter and surgical aortic valve therapies in aortic valve stenosis patients with heart failure

“…26 The implant of PP after TAVR raises concerns of prolonging the hospitalisation and intensive care unit stay, however, in our analysis the total length of stay remained shorter in TAVR patients than SAVR with a lower mortality rate. 27 Aside from medical factors, patients' socioeconomic status appears to play a minor role in our analysis outcome.…”

Oversized versus Non-oversized Prosthesis: Midterm Outcomes after Transcatheter Aortic Valve Replacement Using SAPIEN 3 Valve

“…The PVL remains the Achilles' heel of the TAVR procedures. Except for the influence on the increase in the endocarditis rate, 10 clinical/functional worsening, 11 readmission, congestive heart failure, 12 and 1-year mortality rate, 12,13 PVL ! 2 has been shown in several studies as an independent predic-tor of mortality.…”