A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Abstract

Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.

Patient‐specific computer simulation of transcatheter aortic valve replacement in patients with previous mechanical mitral prosthesis: A case series

“…1 In recent years, operators' experience and patient selection have been improved and actually TAVR is performed in more complex anatomies. 2 The presence of a previously implanted mechanical mitral prosthesis (MMP) represents a challenging scenario due to the risk of interference between the implanted TAVR and the mechanical mitral leaflets, possibly leading to severe regurgitation or obstruction. We present a case series of TAVR in patients with previous MMP, with preprocedural planning including selection of valve type and size and implantation depth based on Artificial Intelligence (AI) simulation models, using patient specific computer tomography reconstruction (FEops HEARTguide).…”

“…Transcatheter aortic valve replacement (TAVR) has emerged as the preferred interventional strategy for elderly patients with severe aortic stenosis (AS) 1 . In recent years, operators' experience and patient selection have been improved and actually TAVR is performed in more complex anatomies 2 . The presence of a previously implanted mechanical mitral prosthesis (MMP) represents a challenging scenario due to the risk of interference between the implanted TAVR and the mechanical mitral leaflets, possibly leading to severe regurgitation or obstruction.…”

Comparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs

“…Since its clinical introduction in 2002 by Dr. Alain Cribier, transcatheter aortic valve implantation (TAVI) has become a procedure of choice for treating severe symptomatic aortic stenosis (AS) in high-risk and elderly patients (1)(2)(3). Continuous research and development of the valve systems improved the outcomes of the patients over the years and reduced complication rates (4)(5)(6)(7)(8).…”

Interference between Venus-A Valve and Anterior Mitral Valve Leaflets after Transcatheter Aortic Valve Replacement: Insight from FEops HEARTguide simulation

“…Transcatheter aortic valve replacement (TAVR) is the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS (1). As the anterior mitral annulus is anatomically linked to both the left and non-coronary aortic cusps through a shared fibrous rim (2), the prosthesis frame mechanically interferes with the anterior mitral leaflet (AML), especially when implanted in a low position.…”