TAVR—present, future, and challenges in developing countries

Bana, Ajeet

doi:10.1007/s12055-018-00786-8

Cited by 8 publications

(5 citation statements)

References 54 publications

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“…Thus, prompt approval for TAVR by the U.S. Food and Drug Administration followed in 2011. By 2014, TAVR was being performed in over 50 countries, in over 720 centers around the world [11].…”

Section: Figurementioning

confidence: 99%

“…These promising results continue to be sustained. By 2025, over a quarter million TAVRs are projected to be performed annually around the world [11]. As more other ongoing global clinical trials continue to suggest both feasibility and safety of TAVR regardless of surgical risk, the paradigm global shifts towards perfecting the solution to severe aortic stenosis are expected to continue.…”

Section: Figurementioning

confidence: 99%

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Catheter-Based Therapies: Current Practices and Considerations

R. Shah,

Golzarian,

M. Patel

2024

Cardiology and Cardiovascular Medicine

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In just over a decade, there have been paradigm shifts globally in the catheter-based therapies available for the management of patients with severe aortic stenosis. The use of transcatheter aortic valve replacement (TAVR) has been a crucial turning point in the field of cardiology as it granted an option for a minimally invasive method to replace a valve for patients who may or may not be suitable for cardiac surgery. In this chapter, we discuss the current practices and considerations as well as the ongoing evolution of catheter-based approaches for TAVR. The predominant focus of the chapter will be on aortic valve device modifications, prototypes of valves, device delivery systems, and the various techniques. However, discussions on indications/contraindications, proper work-up, preparation, equipment and personnel, complications, and post-procedural management & surveillance will also be reviewed.

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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Catheter-Based Therapies: Current Practices and Considerations

R. Shah,

Golzarian,

M. Patel

2024

Cardiology and Cardiovascular Medicine

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“…1 The number of TAVR procedure steadily increases across the world. 2 Two main designs of transcatheter heart valves have been widely used: self-expanding (SEV) and balloon expandable (BEV). A comparison from FRANCE-TAVI registry reported higher rates of paravalvular regurgitation, in-hospital and 2-year mortality with self-expanding transcatheter heart valves.…”

Section: Introductionmentioning

confidence: 99%

“…Nowadays, health care practitioners show a big shift towards transcatheter aortic valve replacement (TAVR) for the management of patients with severe symptomatic aortic stenosis 1 . The number of TAVR procedure steadily increases across the world 2 . Two main designs of transcatheter heart valves have been widely used: self‐expanding (SEV) and balloon expandable (BEV).…”

Section: Introductionmentioning

confidence: 99%

Survival outcomes of TAVR and self‐expanding versus balloon‐expandable valves in patients with advanced cardiac dysfunction

Matta,

Lhermusier,

Ohlmann

et al. 2024

ESC Heart Failure

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AimsThere is a growing body of literature on long‐term outcomes post‐transcatheter aortic valve replacement (TAVR), but to our knowledge, few research have focused on patients with advanced cardiac dysfunction. This challenging category of patients was excluded from the Partner 3 clinical trial. There are no data to guide the choice of valve type in patients with severely depressed ejection fraction. This study evaluates the safety, efficacy, and outcomes of TAVR in patients with severe aortic stenosis and left ventricular ejection fraction (LVEF) ≤ 35%. It compares post‐TAVR survival outcomes with self‐expanding (SEV) versus balloon‐expandable (BEV) valves in the context of cardiac dysfunction.Methods and resultsA retrospective cohort was conducted on 977 patients who underwent TAVR at Toulouse University Hospital between January 2016 and December 2020. The study population included two groups: LVEF ≤ 35% (N = 157) and LVEF ≥ 50% (N = 820). The group of LVEF ≤ 35% was divided into two subgroups according to the type of implanted device: self‐expanding (N = 66) versus balloon‐expandable (N = 91). The living status of each of study's participants was observed in December 2022. Patients with low ejection fraction were younger (82 vs. 84.6 years) and commonly males (71.3% vs. 45.6%). Procedural success was almost 98% in both study groups (97.5% vs. 97.9%). The prevalence of all in‐hospital post‐TAVR complications [acute kidney injury (3.8% vs. 2.2%), major bleeding events (2.5% vs. 3.2%), stroke (1.3% vs. 1.6%), pacemaker implantation (10.2% vs. 10.7%), major vascular complication (4.5% vs. 4.5%), new onset atrial fibrillation (3.2% vs. 3.4%), and in‐hospital death (3.2% vs. 2.8%)] were similar between groups (LVEF ≤ 35% vs. LVEF ≥ 50%). No difference in long‐term survival has been revealed over 3.4 years (P = 0.268). In patients with LVEF ≤ 35%, except for post‐TAVR mean aortic gradient (7.8 ± 4.2 vs. 10.2 ± 3.6), baseline and procedural characteristics were comparable between SEV versus BEV subgroups. An early improvement in LVEF (from 29.2 ± 5.5 to 37.4 ± 10.8) was observed. In patients with LVEF ≤ 35%, the all‐cause mortality rate was significantly higher in BEV than that in SEV subgroups, respectively (40.7% vs. 22.7%, P = 0.018). Kaplan–Meier curve showed better survival outcomes after SEV implantation (P = 0.032). A Cox regression identified BEV as independent predictor of mortality [HR = 3.276, 95% CI (1.520–7.060), P = 0.002].ConclusionsIn the setting of low LVEF, TAVR remains a safe and effective procedure not associated with an increased risk of complications and mortality. SEV implantation may likely result in superior survival outcomes in patients with advanced cardiac dysfunction.

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“…It is becoming an increasingly more utilized treatment option over traditional surgical aortic valve replacement (SAVR) in many patient populations [2]. The major driving factor to this trend is due to emerging data showing an overall decrease in mortality and procedure-related complications coupled with patients and physicians' desire for the less invasive procedures [3]. TAVR was originally utilized for high surgical risk patients, and it showed superiority over SAVR in this population [4].…”

Section: Introductionmentioning

confidence: 99%

Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair

Shah¹,

Krinock²,

Thyagaturu³

et al. 2021

Cureus

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BackgroundPericardial disease (PD) -acute pericarditis (AP) and pericardial effusion (PE) -is a rare complication of transcatheter aortic valve repair (TAVR) although its prevalence, predictors, and outcomes are not well studied. MethodsWe used the National Inpatient Sample (NIS) database to find patients who received TAVR between 2011 and 2018. TAVR patients were divided into two groups: with and without PD (AP and/or PE). The baseline characteristics between the two groups were compared using the Chi-square test and student t-test. Variables with a p-value of 0.20 or less from the univariate logistic regression were included in the multivariate logistic regression to find independent predictors of PD in TAVR patients. ResultsOut of 218,340 TAVR hospitalizations, 4323 (1.2%) had a concurrent diagnosis of PD. TAVR patients with PD were older (81 ± 7 vs 80 ± 6 years, p < 0.05), more likely to be females (62 vs 46%, p < 0.001), white (84.2 vs 82.9%, p = 0.83), and had a higher burden of comorbidities (Table 3). TAVR patients with PD had higher inhospital mortality rate (12.3 vs 1.9%, p < 0.001), mean length of stay (8.4 vs 5.3 days, p < 0.001), and mean total hospital cost ($283,389 vs $224,544, p < 0.001). Age > 75, female sex, atrial fibrillation (Afib), atrial flutter (Aflutter), peripheral vascular disease (PVD), coagulopathy, cirrhosis, malnutrition, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and pacemaker (PM) implantation were the independent predictors of PD in TAVR patients. ConclusionOlder, white females with a higher burden of comorbidities and cardiovascular procedures are at higher risk of pericardial complications of TAVR procedure. Sex-based disparities in the prevalence of PD after TAVR is an area of further research. Careful selection of patients for TAVR is essential to reduce the burden of these complications.

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TAVR—present, future, and challenges in developing countries

Cited by 8 publications

References 54 publications

Catheter-Based Therapies: Current Practices and Considerations

Catheter-Based Therapies: Current Practices and Considerations

Survival outcomes of TAVR and self‐expanding versus balloon‐expandable valves in patients with advanced cardiac dysfunction

Temporal Trend, Prevalence, Predictors, and Outcomes of Pericardial Diseases in Patients Undergoing Transcatheter Aortic Valve Repair

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