Heart failure following transcatheter aortic valve replacement

ABSTRACT

Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.

Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.

Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.

KEYWORDS:

• Heart failure
• hfpef
• hfref
• tavi
• tavr
• valvular disease

Article highlights

• Post-TAVR readmission is frequent, and heart failure (HF) is the most common cardiac related cause of rehospitalization

• Pre-existing factors like low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, coronary artery disease, and arrhythmias have been identified as contributing factors

• A comprehensive reevaluation and optimal management of associated heart disease would be important to prevent HF events following TAVR

• Procedural complications including residual paravalvular leaks and conduction disturbances must be avoided and, if present, close follow-up and appropriate treatment should be implemented within the months following the procedure

• Further studies are warranted to evaluate medical cardioprotective therapies and specific treatments of associated diseases in the TAVR population

Declaration of interest

V Panagides has received research grant from Medtronic, Boston scientific and microport. J Rodes-Cabau holds the Research Chair “Fondation Famille Jacques Larivière” for the Development of Structural Heart Disease Interventions, and has received institutional research grants from and is a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. The authors have no other 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 apart from those disclosed.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.