Recent advances in transcatheter aortic valve replacement for high-risk patients

Abstract

Aortic stenosis is the most common valvular heart disease of old age. Patients with severe aortic stenosis who develop symptoms have a very poor prognosis without valve intervention. Surgical aortic valve replacement has historically been the only treatment option for these patients. However a significant minority are considered inoperable or at high surgical risk and therefore are refused or decline surgery. In recent years, transcatheter aortic valve replacement has emerged as an alternative treatment option in these high-risk patients. The aim of this review is to summarize the current role of transcatheter aortic valve replacement in contemporary clinical practice including recent advances in technological and procedural aspects and then discuss future directions.

Keywords:

• aortic stenosis
• TAVR
• Transcatheter aortic valve replacement

Financial & competing interests disclosure

A Latib is a consultant for Direct Flow Medical and Medtronic. A Colombo is a minor shareholder in Direct Flow Inc. 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.

Key issues

• Transcatheter aortic valve replacement (TAVR) is now established as the treatment option of choice for patients presenting with severe symptomatic aortic stenosis or who are deemed to be inoperable or of high surgical risk.

• Prior to considering TAVR as a potential treatment option, thorough clinical evaluation is mandatory, to determine suitability, exclude contraindications and to aid in procedural planning.

• The expertise of the ‘Heart Team’ is central to clinical decision making in this patient group.

• There have been rapid advancements in transcatheter valve (and delivery system) design in the last few years, with a number of devices currently available.

• With greater operator experience in conjunction with technological advancements, TAVR is increasingly being used for traditionally ‘off-label’ indications, with the results of large registries, clinical trials with longer-term follow-up awaited.

• In the future, the use of TAVR may also be expanded to treating lower-risk patients.

Notes