Current and new-generation transcatheter aortic valve devices: an update on emerging technologies

Abstract

Transcatheter aortic valve implantation (TAVI) has become an accepted treatment option for patients with symptomatic severe aortic stenosis who are at high risk for traditional surgical aortic valve replacement. In particular, TAVI has been shown to reduce mortality in a randomized comparison with medical treatment and to be non-inferior to surgical aortic valve replacement in ‘high-risk operable’ patients. From its early stages it became apparent that TAVI has tremendous potential and thus considerable efforts were made to design new devices and advance valve technology in order to improve outcomes and increase TAVI applications in complex anatomies and in patients with multiple co-morbidities. In this review, we present the advances in transcatheter aortic valve technology and discuss the current evidence on the new-generation TAVI devices.

Keywords::

• aortic stenosis
• balloon valvuloplasty
• outcomes
• transcatheter heart valve
• transcatheter aortic valve implantation

Financial & competing interests disclosure

A Latib has consulted or received honoraria from Medtronic, Edwards and Direct Flow. 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 dis-cussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grant or patents received or pending or royalties.

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

Key issues

• • Transcatheter aortic valve implantation (TAVI) has become an accepted treatment option for patients with symptomatic severe aortic stenosis who are at high risk for traditional surgical aortic valve replacement (SAVR).

• • TAVI has been shown to reduce mortality in a randomized comparison with medical treatment and to be non-inferior to SAVR in ‘high-risk operable’ patients.

• • The current evidence has shown TAVI feasibility and efficacy and drawn the attention of industry and physicians.

• • Several TAVI limitations, including paravalvular leak, vascular complications, pacemaker implantation, device malposition, annular rupture and coronary occlusion, still remain.

• • Over the last few years, a considerable effort has been made to create new transcatheter heart valves (THV) and enabling devices that will overcome the limitations of the first-generation THV.

• • Several new THV devices have been developed that are easier to implant in an optimal position, adapt and conform better to the native anatomy to reduce paravalvular leak and reduce the risk of complications (i.e., vascular, conduction disturbances).

• • Currently, the data supporting newer THVs are limited to highly selected patients.

• • New-generation THV devices will be able to offer to an increasing number of patients an alternative way of improving outcomes and quality of life.