Emerging transcatheter heart valve technologies for severe aortic stenosis

ABSTRACT

Introduction

Transcatheter aortic valve implantation (TAVI) is the standard of care for selected patients with severe aortic stenosis, irrespective of the surgical risk. Over the last two decades of TAVI practice, multiple limitations were identified. In addition, the extension of TAVI into a wider patient spectrum created new challenges.

Areas covered

This review provides an overview of emerging transcatheter heart valves (THVs) beyond the approved contemporary THVs for the treatment of aortic stenosis.

Expert opinion

The incidence of degenerative aortic stenosis is expected to increase with more aging of the population. Therefore, TAVI needs to meet this increase in the number of patients indicated for aortic valve replacement alongside a wide and complex anatomical variability. An increasing number of Aortic THVs are available in the market. This includes upgraded iterations of contemporary devices and innovative devices developed by emerging manufacturers. The new devices aim for the reduction or elimination of undesirable outcomes like paravalvular leakage and conduction disturbances requiring permanent pacemaker implantation. Alternatively, emerging THVs should provide feasibility regarding yet unproven TAVI indications like Bicuspid aortic valve, aortic regurgitation, or very large anatomy. Furthermore, some of the emerging THVs are designed to tackle the long-term durability issue of biological valves.

KEYWORDS:

• Aortic stenosis
• aortic valve replacement
• prosthetic valve
• transcatheter devices
• transcatheter aortic valve implantation
• TAVI
• transcatheter heart valves

Article highlights

• Transcatheter aortic valve implantation (TAVI) become an established treatment for patients with severe Aortic stenosis.

• TAVI device development showed an accelerated rhythm over the last decade.

• Multiple TAVI devices were introduced with multiple iterations of the same device and by the same manufacturer.

• The development of contemporary devices and the introduction of totally new devices is based on and inspired by the identified limitations of the previous and current practice.

• Clinical unmet needs are still emerging especially with the accelerated expansion of TAVI indications.

• Optimized TAVI practice and obtaining the best outcomes might be achieved through adopting the concept of ‘patient’s specific procedure planning and device selection.’

List of abbreviations

AR	=	Aortic Regurgitation
AS	=	Aortic stenosis
BAV	=	Bicuspid Aortic Valve
BEV	=	Balloon Expandable Valve
DS	=	Delivery System
PVL	=	Paravalvular Leakage
TAVI	=	Transcatheter Aortic Valve Implantation
THV	=	Transcatheter Heart Valve
SAVR	=	Surgical Aortic Valve replacement
SEV	=	Self Expandable Valve

Reviewer disclosures

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

Declaration of interests

A Elkoumy and H Elzomor are supported by the University of Galway. O Soliman is supported by the University of Galway and has received several industrial and non-industrial grants. D Mylotte has served as a consultant for Medtronic, Boston Scientific and MicroPort. 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.

Additional information

Funding

This paper was not funded.