The current status of transcutaneous aortic valve implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is a relatively novel procedure first performed in 2002 and has undergone rapid development since then. Its main indication is treatment of severe symptomatic aortic valve stenosis. Initially, the procedure was indicated for very sick patients who were not eligible for surgical aortic valve replacement. However, rapid development of the technology and operator skill required for TAVI allowed widening of the indications for its use. Currently, there is evidence that TAVI could be better than the surgical intervention in a broad population and not only in the most sick. This paper reviews the medical literature regarding TAVI, including the relevant medical equipment, different modes of its deployment, main complications of the procedure, main indications and contraindications, and the outcome of the patients who undergo it.

Keywords::

• aortic stenosis
• Edwards SAPIEN device
• Medtronic CoreValve revalving system
• surgical aortic valve replacement
• transcatheter aortic valve implantation
• transcatheter heart valve

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Initially, transcatheter aortic valve implantation (TAVI) was designed as a last resort for patients with severe aortic stenosis who were too sick to undergo surgical aortic valve replacement, which was the definitive treatment for this condition.

• Currently, there is evidence that TAVI can be non-inferior and even superior to surgical aortic valve replacement in various populations including patients with low and intermediate surgical risk.

• The two most widely used devices for TAVI are Edwards Lifesciences SAPIEN device and Medtronic CoreValve device.

• Many other devices such as novel generations of the aforementioned devices, Boston Scientific Lotus device and St Jude Medical Portico device develop constantly.

• The rate of major complications of TAVI diminishes with the improvement of the bioprostheses and the delivery systems and with learning curves of the operators.

• Performing the TAVI demands the presence of Heart Team, that is, a team of invasive cardiologists, heart surgeons, anaesthesiologists and imaging specialists on site.

• The main issue for performing the TAVI is patient selection and also selecting the correct approach for the patients taking into consideration his or her individual parameters.

• New risk score to predict the outcome of TAVI is essential.