Transcatheter aortic valve replacement: where will we be in 5 years?

Cheung, Anson; Soon, Jia-Lin

doi:10.1097/hco.0b013e32834398ba

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…Transcatheter aortic valve implantation (TAVI) has been developed as a treatment strategy for patients with severe aortic stenosis who are at high risk or not eligible for heart surgery [29]. Several studies have demonstrated that MDCT is an ideal imaging modality prior to TAVI, providing isotropic datasets of the aortic root that can be reformatted in any spatial orientation [30]–[32].…”

Section: Discussionmentioning

confidence: 99%

CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters

et al. 2014

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Background/ObjectivesTo evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI) and to calculate optimal cutoff values for the selection of various prosthesis sizes.MethodsThe local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67). In the remaining 351 patients, the CoreValve (Medtronic) and the Edwards Sapien XT valve (Edwards Lifesciences) were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values.ResultsDifferences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p’s<0.05). Furthermore, mean diameter, annulus area and circumference had equally high predictive value for prosthesis size for both manufacturers (multi-class AUC’s: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89). Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases.ConclusionCT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI.

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Section: Discussionmentioning

confidence: 99%

CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters

et al. 2014

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“…In addition, bulky leaflet calcification poses a risk for occlusion of the coronary ostium. 33 The Sapien valve is not affected by sinotubular junction measurements as its profile is lower. However, there should be a minimum distance of 10-11 mm between the aortic annulus and the coronary ostium (particularly the left).…”

Section: Measurements Of the Aortic Annulusmentioning

confidence: 94%

“…Annular/leaflet calcification is required for the placement of the transcatheter valve; however, calcification‐related annular asymmetry residues also lead to paravalvular insufficiency. In addition, bulky leaflet calcification poses a risk for occlusion of the coronary ostium . The Sapien valve is not affected by sinotubular junction measurements as its profile is lower.…”

Section: Aortic Valve Morphology and Coronary Ostiumsmentioning

confidence: 99%

The Importance of Echocardiography in Transcatheter Aortic Valve Implantation

et al. 2013

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Valvular heart diseases cause serious health problems in Turkey as well as in Western countries. According to a study conducted in Turkey, aortic stenosis (AS) is second after mitral valve disease among all valvular heart diseases. AS is frequently observed in elderly patients who have several cardiovascular risk factors and comorbidities. In symptomatic severe AS, surgical aortic valve replacement (AVR) is a definitive treatment. However, in elderly patients with left ventricular dysfunction and comorbidities, the risk of operative morbidity and mortality increases and outweighs the gain obtained from AVR surgery. As a result, almost one-third of the patients with serious AS are considered ineligible for surgery. Transcatheter aortic valve implantation (TAVI) is an effective treatment in patients with symptomatic severe AS who have high risk for conventional surgery. Since being performed for the first time in 2002, with a procedure success rate reported as 95% and a mortality rate of 5%, TAVI has become a promising method. Assessment of vascular anatomy, aortic annular diameter, and left ventricular function may be useful for the appropriate selection of patients and may reduce the risk of complications. Cardiac imaging methods including 2D and 3D echocardiography and multidetector computed tomography are critical during the evaluation of suitable patients for TAVI as well as during and after the procedure. In this review, we describe the role of echocardiography methods in clinical practice for TAVI procedure in its entirety, i.e. from patient selection to guidance during the procedure, and subsequent monitoring.

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“…In the past decade, the increased usage of TAVI has led to rapid development and improvement in techniques and device designs. To date, the success of TAVI among intermediate‐risk patients has led to attempts to expand its use in younger patients who are low‐risk candidates for SAVR . However, major questions still remain for TAVI before we can generalize this procedure.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve implantation: The evolving role of surgeons and challenges ahead

et al. 2018

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Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis. Multiple seminal trials have firmly established TAVI as an effective and the preferred treatment in patients at high risk for surgical aortic valve replacement (SAVR). Following the success of the Placement of AoRTic TraNscath-etER(PARTNER) 1 trial, TAVI was further proven to be a viable alternative to SAVR, with patients found to be at lower risk in the PARTNER 2 and Surgical or Transcatheter Aortic-Valve Replacement (SURTAVI) trials. Contrary to the development of coronary intervention, surgeons from many parts of the world have adopted an active role in TAVI, rather than merely providing access. Moreover, as the use of TAVI has increased worldwide, and with developments in techniques and devices, experts are trying to expand the indications of TAVI to patients who are younger, fitter and at low risk for SAVR. Nonetheless, important questions concerning the risks and durability of TAVI remain unanswered. As the evolution of TAVI continues to gather pace, it is important for clinicians to critically evaluate the merits and shortcomings of TAVI to determine its suitability for low-risk patients. The present review serves to highlight and discuss some of the challenges TAVI needs to overcome before its role in low risk patients can be established.

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Transcatheter aortic valve replacement: where will we be in 5 years?

Cited by 5 publications

References 27 publications

CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters

CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters

The Importance of Echocardiography in Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation: The evolving role of surgeons and challenges ahead

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