TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

Spears, Jenna; Al-Saiegh, Yousif; Goldberg, David M.; Manthey, Sina; Goldberg, Sheldon

doi:10.1155/2020/2582938

Cited by 42 publications

(32 citation statements)

References 75 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, improvement of the quality of pre-interventional analysis, physicians experience and development of newer generation devices have mitigated some of these clinical complications and enhanced its performance in patients with various pre-operative risks. The high prevalence of BAV in younger aortic stenosis patients, coupled with the worldwide expansion of TAVR use among younger and lower surgical-risk patients, including BAV patients [6][7][8][9][10], establishes a compelling need for strategies to avoid procedural complications, which appears to be frequent in this subgroup of patients. After being used as an off-label treatment option for a long time, TAVR was recently being approved for BAV patient population by the US Food and Drug Administration and European Conformity [9].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling

Anam

Kovarovic

Ghosh

et al. 2021

J. of Cardiovasc. Trans. Res.

View full text Add to dashboard Cite

Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients -using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes.

show abstract

Section: Introductionmentioning

confidence: 99%

Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling

Anam

Kovarovic

Ghosh

et al. 2021

J. of Cardiovasc. Trans. Res.

View full text Add to dashboard Cite

show abstract

“…Historically, TAVI candidates were recruited among patients thought to have a prohibitively high surgical risk. We are witnessing a paradigm shift as the proportion of patients treated with TAVI is increasing worldwide and increas- ingly lower risk patients are being recruited (12,13,14). Surgery, however, remains the standard of care, as it offers reproducible long-term results and is much less likely to be associated with paravalvular leaks, new onset third degree AV block and vascular access related complications; all of which burden TAVI (15).…”

Section: Discussionmentioning

confidence: 99%

Contemporary trends in the surgical management of aortic valve disease

Gašparović¹,

Čerina²,

Ćepulić³

et al. 2021

Rad Hrvatske akademije znanosti i umjetnosti

View full text Add to dashboard Cite

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treatment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb's cardiac surgical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichotomized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in comparison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the contemporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard.

show abstract

“…Transcatheter aortic valve implantation (TAVI) is an established treatment for high-risk patients which are not eligible for surgery. Recently, guidelines were updated and TAVI was introduced as a possible treatment for a larger population which include intermediate-risk patients (4)(5)(6)(7). TAVI demonstrated significant survival benefit in the short-term follow ups across the spectrum of intermediate and high-risk patients when compared to the classical surgical valve replacement (SVR) (8,9).…”

Section: Introductionmentioning

confidence: 99%

Characterization of Turbulent Flow Behind a Transcatheter Aortic Valve in Different Implantation Positions

Pietrasanta

Zheng

Marinis

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

The development of turbulence after transcatheter aortic valve (TAV) implantation may have detrimental effects on the long-term performance and durability of the valves. The characterization of turbulent flow generated after TAV implantation can provide fundamental insights to enhance implantation techniques. A self-expandable TAV was tested in a pulse replicator and the three-dimensional flow field was extracted by means of tomographic particle image velocimetry. The valve was fixed inside a silicone phantom mimicking the aortic root and the flow field was studied for two different supra-annular axial positions at peak systole. Fluctuating velocities and turbulent kinetic energy were compared between the two implantations. Velocity spectra were derived at different spatial positions in the turbulent wakes to characterize the turbulent flow. The valve presented similar overall flow topology but approximately 8% higher turbulent intensity in the lower implantation. In this configuration, axial views of the valve revealed smaller opening area and more corrugated leaflets during systole, as well as more accentuated pinwheeling during diastole. The difference arose from a lower degree of expansion of the TAV's stent inside the aortic lumen. These results suggest that the degree of expansion of the TAV in-situ is related to the onset of turbulence and that a smaller and less regular opening area might introduce flow instabilities that could be detrimental for the long-term performance of the valve. The present study highlights how implantation mismatches may affect the structure and intensity of the turbulent flow in the aortic root.

show abstract

TAVR: A Review of Current Practices and Considerations in Low-Risk Patients

Cited by 42 publications

References 75 publications

Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling

Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling

Contemporary trends in the surgical management of aortic valve disease

Characterization of Turbulent Flow Behind a Transcatheter Aortic Valve in Different Implantation Positions

Contact Info

Product

Resources

About