Abstract
Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement (TAVR), is a revolutionary minimally invasive procedure designed to treat severe aortic stenosis in patients who are deemed high-risk or inoperable for traditional surgical aortic valve replacement. This innovative technique involves the percutaneous delivery and deployment of a bioprosthetic valve via a catheter-based system, obviating the need for open-heart surgery.
TAVI has gained widespread acceptance and popularity due to its remarkable clinical outcomes and reduced perioperative morbidity and mortality compared to conventional surgical interventions. The procedure is typically performed using either transfemoral, transapical, transaortic, or trans-subclavian approaches, catering to a diverse range of patient anatomies and clinical conditions. Various types of transcatheter heart valves are available, including balloon-expandable and self-expanding valves, each offering distinct advantages in specific patient cohorts.
Long-term follow-up data indicate excellent valve functionality and sustained clinical benefits, making TAVI a transformative treatment option for elderly patients with severe aortic stenosis. Nonetheless, ongoing research and advancements in technology continue to refine and expand the indications for TAVI, offering new hope to patients who were once considered ineligible for valve replacement.
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References
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.
Yadgir S, Johnson CO, Aboyans V, Adebayo OM, Adedoyin RA, Afarideh M, et al. Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017. Circulation. 2020;141(21):1670–80.
Lindman BR, Clavel MA, Mathieu P, Iung B, Lancellotti P, Otto CM, et al. Calcific aortic stenosis. Nat Rev Dis Primers. 2016;2:16006.
Genereux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA, et al. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J. 2017;38(45):3351–8.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98.
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–8.
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.
Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, et al. STS- ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;76(21):2492–516.
Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, et al. Initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2015;66(25):2827–38.
Spitzer E, Van Mieghem NM, Pibarot P, Hahn RT, Kodali S, Maurer MS, et al. Rationale and design of the Transcatheter aortic valve replacement to UNload the left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial. Am Heart J. 2016;182:80–8.
Strange G, Stewart S, Celermajer D, Prior D, Scalia GM, Marwick T, et al. Poor long- term survival in patients with moderate aortic stenosis. J Am Coll Cardiol. 2019;74(15):1851–63.
O'Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2—isolated valve surgery. Ann Thorac Surg. 2009;88(1 Suppl):S23–42.
Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–44; discussion 44–5.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561–632.
Faroux L, Guimaraes L, Wintzer-Wehekind J, Junquera L, Ferreira-Neto AN, Del Val D, et al. Coronary artery disease and transcatheter aortic valve replacement: JACC state-of- the-art review. J Am Coll Cardiol. 2019;74(3):362–72.
Witberg G, Regev E, Chen S, Assali A, Barbash IM, Planer D, et al. The prognostic effects of coronary disease severity and completeness of revascularization on mortality in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2017;10(14):1428–35.
Thalji NM, Suri RM, Daly RC, Greason KL, Dearani JA, Stulak JM, et al. The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. J Thorac Cardiovasc Surg. 2015;149(2):451–60.
Thiele H, Kurz T, Feistritzer HJ, Stachel G, Hartung P, Lurz P, et al. General versus local anesthesia with conscious sedation in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial. Circulation. 2020;142(15):1437–47.
Dangas GD, Lefevre T, Kupatt C, Tchetche D, Schafer U, Dumonteil N, et al. Bivalirudin versus heparin anticoagulation in transcatheter aortic valve replacement: the randomized BRAVO-3 trial. J Am Coll Cardiol. 2015;66(25):2860–8.
Brinkert M, Mangner N, Moriyama N, Keller LS, Hagemeyer D, Crusius L, et al. Safety and efficacy of transcatheter aortic valve replacement with continuation of vitamin K antagonists or direct oral anticoagulants. JACC Cardiovasc Interv. 2021;14(2):135–44.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, et al. 2015 ESC guidelines for the management of infective endocarditis: the task force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075–128.
Stortecky S, Heg D, Tueller D, Pilgrim T, Muller O, Noble S, et al. Infective endocarditis after transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;75(24):3020–30.
van Wiechen MP, Tchetche D, Ooms JF, Hokken TW, Kroon H, Ziviello F, et al. Suture- or plug-based large-bore arteriotomy closure: a pilot randomized controlled trial. JACC Cardiovasc Interv. 2021;14(2):149–57.
Vavuranakis M, Kalogeras KI, Vrachatis DA, Kariori MG, Aznaouridis K, Moldovan C, et al. A modified technique to safely close the arterial puncture site after TAVI. J Invasive Cardiol. 2013;25(1):45–7.
Lanz J, Greenbaum A, Pilgrim T, Tarantini G, Windecker S. Current state of alternative access for transcatheter aortic valve implantation. EuroIntervention. 2018;14(AB):AB40–52.
Dahle TG, Kaneko T, McCabe JM. Outcomes following subclavian and axillary artery access for transcatheter aortic valve replacement: Society of the Thoracic Surgeons/American College of Cardiology TVT registry report. JACC Cardiovasc Interv. 2019;12(7):662–9.
Bapat V, Khawaja MZ, Attia R, Narayana A, Wilson K, Macgillivray K, et al. Transaortic transcatheter aortic valve implantation using Edwards Sapien valve: a novel approach. Catheter Cardiovasc Interv. 2012;79(5):733–40.
Chamandi C, Abi-Akar R, Rodes-Cabau J, Blanchard D, Dumont E, Spaulding C, et al. Transcarotid compared with other alternative access routes for transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2018;11(11):e006388.
Athappan G, Patvardhan E, Tuzcu EM, Svensson LG, Lemos PA, Fraccaro C, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61(15):1585–95.
Pibarot P, Hahn RT, Weissman NJ, Arsenault M, Beaudoin J, Bernier M, et al. Association of paravalvular regurgitation with 1-year outcomes after transcatheter aortic valve replacement with the SAPIEN 3 valve. JAMA Cardiol. 2017;2(11):1208–16.
Ribeiro HB, Nombela-Franco L, Urena M, Mok M, Pasian S, Doyle D, et al. Coronary obstruction following transcatheter aortic valve implantation: a systematic review. JACC Cardiovasc Interv. 2013;6(5):452–61.
Abramowitz Y, Chakravarty T, Jilaihawi H, Kashif M, Kazuno Y, Takahashi N, et al. Clinical impact of coronary protection during transcatheter aortic valve implantation: first reported series of patients. EuroIntervention. 2015;11(5):572–81.
Pasic M, Unbehaun A, Buz S, Drews T, Hetzer R. Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv. 2015;8(1 Pt A):1–9.
Kim WK, Schafer U, Tchetche D, Nef H, Arnold M, Avanzas P, et al. Incidence and outcome of peri-procedural transcatheter heart valve embolization and migration: the TRAVEL registry (TranscatheteR HeArt valve EmboLization and migration). Eur Heart J. 2019;40(38):3156–65.
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–705.
Genereux P, Webb JG, Svensson LG, Kodali SK, Satler LF, Fearon WF, et al. Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER valve) trial. J Am Coll Cardiol. 2012;60(12):1043–52.
Scarsini R, De Maria GL, Joseph J, Fan L, Cahill TJ, Kotronias RA, et al. Impact of complications during transfemoral transcatheter aortic valve replacement: how can they be avoided and managed? J Am Heart Assoc. 2019;8(18):e013801.
Maeno Y, Abramowitz Y, Kawamori H, Kazuno Y, Kubo S, Takahashi N, et al. A highly predictive risk model for pacemaker implantation after TAVR. JACC Cardiovasc Imaging. 2017;10(10 Pt A):1139–47.
Siontis GCM, Overtchouk P, Cahill TJ, Modine T, Prendergast B, Praz F, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40(38):3143–53.
Vlastra W, Jimenez-Quevedo P, Tchetche D, Chandrasekhar J, de Brito FS Jr, Barbanti M, et al. Predictors, incidence, and outcomes of patients undergoing transfemoral transcatheter aortic valve implantation complicated by stroke. Circ Cardiovasc Interv. 2019;12(3):e007546.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;143(5):e35–71.
Brouwer J, Nijenhuis VJ, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020;383(15):1447–57.
Nijenhuis VJ, Brouwer J, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, et al. Anticoagulation with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020;382(18):1696–707.
Vavuranakis M, Kalogeras K, Kolokathis AM, Vrachatis D, Magkoutis N, Siasos G, et al. Antithrombotic therapy in TAVI. J Geriatr Cardiol. 2018;15(1):66–75.
Kalogeras K, Jabbour RJ, Ruparelia N, Watson S, Kabir T, Naganuma T, et al. Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry. J Thromb Thrombolysis. 2020;50(1):82–9.
Blackman DJ, Saraf S, MacCarthy PA, Myat A, Anderson SG, Malkin CJ, et al. Long-term durability of transcatheter aortic valve prostheses. J Am Coll Cardiol. 2019;73(5):537–45.
Testa L, Latib A, Brambilla N, De Marco F, Fiorina C, Adamo M, et al. Long-term clinical outcome and performance of transcatheter aortic valve replacement with a self-expandable bioprosthesis. Eur Heart J. 2020;41(20):1876–86.
Sondergaard L, Ihlemann N, Capodanno D, Jorgensen TH, Nissen H, Kjeldsen BJ, et al. Durability of transcatheter and surgical bioprosthetic aortic valves in patients at lower surgical risk. J Am Coll Cardiol. 2019;73(5):546–53.
Pibarot P, Ternacle J, Jaber WA, Salaun E, Dahou A, Asch FM, et al. Structural deterioration of transcatheter versus surgical aortic valve bioprostheses in the PARTNER-2 trial. J Am Coll Cardiol. 2020;76(16):1830–43.
Rodriguez-Gabella T, Voisine P, Puri R, Pibarot P, Rodes-Cabau J. Aortic bioprosthetic valve durability: incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. J Am Coll Cardiol. 2017;70(8):1013–28.
Capodanno D, Petronio AS, Prendergast B, Eltchaninoff H, Vahanian A, Modine T, et al. Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017;38(45):3382–90.
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Kalogeras, K., Vavuranakis, M. (2024). Transcatheter Aortic Valve Implantation. In: Geroulakos, G., Avgerinos, E., Becquemin, J.P., Makris, G.C., Froio, A. (eds) Mastering Endovascular Techniques. Springer, Cham. https://doi.org/10.1007/978-3-031-42735-0_40
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