Transcatheter Aortic Valve Implantation Current Indications and Future Directions

Abstract

Degenerative heart valve disease is associated with significant morbidity and mortality and healthcare expenditures. Transcatheter heart valve repair and replacement has introduced a fundamental change in the therapeutic management and transcatheter aortic valve replacement (TAVR) has gained substantial popularity. Favorable results from randomized trials and large real world registries lead to TAVR being considered a standard procedure with high rates of procedural success and low rates of peri-procedural complications. This article aims to review the past evolution, summarize the available evidence, discuss current indications and limitations and venture a glimpse into the future of percutaneous interventions for aortic valve disease.

A Evolução Do Implante Valvar Aórtico Transcateter: Revisão De Literatura / The Evolution Of Aortic Valve Transcateter Implant Indication: Literature Review

“…Tal associação conflui para uma alta taxa de mortalidade pós-procedimento neste grupo de mais de 30% em 1 ano (PURI, 2016). (WINKEL et al, 2019).…”

“…Descobrir se a presença de 2 válvulas afeta a durabilidade das próteses e contornar a possibilidade de trombose dos folhetos valvares são desafios para o futuro do método(BARBANTI et al, 2016). auxiliar na identificação dos pacientes que se beneficiariam de uma intervenção precoce (WINKEL et al, 2019)…”

Patient‐specific in vitro testing for evaluating TAVR clinical performance—A complementary approach to current ISO standard testing

“…Complications of TAVR include: thrombosis and stroke, paravalvular leaks (PVL—leaks around the device between the stent and the calcified native valve), device migration, cardiac conduction abnormalities (CCA) that may necessitate permanent pacemaker implantation (PPI), hypo‐attenuated leaflet thickening ((HALT)—thrombus build up on the TAVR leaflets restricting opening), and coronary obstruction 8 . Furthermore, the long‐term durability of TAVR remains unknown, with limited data on valve durability and rates of structural valve deterioration (SVD) beyond 7 years of follow‐up 10 . This is a particular concern for TAVR procedures in younger patients 11 .…”

“…15,[17][18][19] Testing a TAVR device performance under patient-specific conditions would yield clinically relevant information that current ISO testing guidelines cannot provide. We evaluated the performance of a novel polymeric TAVR device, advocated as the future of TAVR technology by addressing many TAVR's clinical complications, 10,20,21 in order to optimize its design for better clinical performance prior to clinical trials. The deployment and hemodynamic performance of TAVR valves were studied in custom fabricated patient-specific calcified aortic valve replicas, reconstructed from CT scans of presurgical TAVR patients.…”

“…8 Furthermore, the long-term durability of TAVR remains unknown, with limited data on valve durability and rates of structural valve deterioration (SVD) beyond 7 years of follow-up. 10 This is a particular concern for TAVR procedures in younger patients. 11 Beyond all of the above, recent reports have identified that prosthesis-patient mismatch (PPM), characterized by a hemodynamically underperforming TAVR device, is a significant, potentially modifiable, complication associated with higher mortality; with severe and moderate PPM present in 12% and 25% of 62,125 patients monitored from 2014 to 2017.…”