Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve

Bagur, Rodrigo; Pîbarot, Philippe; Otto, Catherine M.

doi:10.1136/heartjnl-2017-312348

Cited by 32 publications

(20 citation statements)

References 28 publications

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“…Some factors specific to TAVI devices and procedures may increase the mechanical stress on valve leaflets and disturb transvalvular flow patterns, which may, in turn, promote accelerated valve deterioration. Schematic representations of the transcatheter valves with structural or non-structural SVD are adapted with permission from 56. DVI, Doppler velocity index; EOA, effective orifice area; LV, left ventricle; SVD, structural valve deterioration; TAVI, transcatheter aortic valve implantation.…”

Section: Definition Of Bioprosthetic Valve Deteriorationmentioning

confidence: 99%

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Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.

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Section: Definition Of Bioprosthetic Valve Deteriorationmentioning

confidence: 99%

“…Figure 6 present an algorithm for the selection of TAVI versus SAVR according to the valve durability to life expectancy ratio and the estimated surgical risk 56. This algorithm will have to be updated when new data on long-term durability of transcatheter bioprostheses will become available.…”

Section: Future Perspectives: Matching Valve Durability Versus Patienmentioning

confidence: 99%

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Salaün

Clavel

Rodés‐Cabau

et al. 2018

Heart

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“…However, there are important structural and procedural differences that could result in a difference in durability: (1) leaflet thickness, (2) presence of native AV calcification, and (3) oval-shaped annulus. 35 In order to allow transcatheter delivery, TAV leaflets are thinner (∼0.25 mm) than the SAV leaflets (∼0.4 mm). 36 Moreover, higher stress and strain are applied to the TAV leaflets during the procedure compared with SAV leaflets.…”

Section: Long-term Durability Of Bioprosthetic Valvesmentioning

confidence: 99%

Current Key Issues in Transcatheter Aortic Valve Replacement Undergoing a Paradigm Shift

Hwang

Hayashida²,

Kim

2019

Circ J

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“…Hence, performing TAVI with a device that does not jail the coronary ostia would, perhaps, be advisable (15)(16)(17)19). In addition, while TAVI is nowadays extended to lower-risk, younger, and less morbid patients, also exhibiting a longer life-expectancy (20), it may be reasonable to proceed with coronary revascularization to prevent the aforementioned potential issue of coronary arteries accessibility should CAD progresses in the future.…”

Section: Timing Of Revascularizationmentioning

confidence: 99%

“…Hence, in the absence of solid randomized data showing superiority results that can further guide clinical decision making, individualized risk-benefit assessments should be undertaken based on patient-risk profile, symptoms and life-expectancy. This pragmatic patient-centered approach has been proposed to guide eligibility of choosing TAVI versus surgical aortic valve replacement in the form of the valve durability to life expectancy ratio (20). Certainly, this concept could also assist decision making in the setting of revascularizing CAD in TAVI candidates by incorporating the benefit and harm of PCI, also bearing in mind the predicted life-expectancy in this subset of patients.…”

Section: Timing Of Revascularizationmentioning

confidence: 99%

Revascularizing coronary artery disease in patients undergoing transcatheter aortic valve implantation

2018

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Coronary artery disease (CAD) is common among p a t i e n t s u n d e r g o i n g t r a n s c a t h e t e r a o r t i c v a l v e implantation (TAVI) with a prevalence of up to 75%, and no clear recommendations around its treatment (1) and conflicting evidence around whether to perform coronary revascularization or not. Moreover, the role of revascularization on long-term morbidity and mortality is still not clear in octogenarians (2). Piccolo and colleagues (3) have provided an interesting editorial comment on our work (1), and further pointed out controversies with regards to revascularization of patients with CAD and undergoing TAVI.The authors also commented on their own results (4), based on an elegant age-and gender-matched analysis where they found a significant increase in the composite of cardiovascular death, myocardial infarction, or stroke at 1-year among TAVI patients with CAD. However, it should be highlighted that the authors found a similar risk of ischemic events during TAVI procedures among patients without CAD as compared to the matched population with CAD. Even when the complexity and severity of CAD is considered and the SYNTAX score is used to stratify CAD severity, the evidence is mixed with regards to mortality outcomes (5,6). Moreover, emerging data on completeness of revascularization is also conflicting. Indeed, while Van Mieghem and colleagues (7) suggested no influence of completeness of revascularization on mortality, a recent large analysis showed that incompleteness of revascularization and more severe CAD were independent predictors of mortality (6).Our findings indicate no benefit in 30-day and 1-year outcomes with a revascularization strategy. Notably, revascularized patients were at higher-risk of major vascular complications, although data were derived from percutaneous coronary intervention (PCI) undertaken through the transfemoral approach and much of the data analysed was subject to the inherent limitations of observational registries such as selection biases and unmeasured confounding. Revascularization strategiesIn terms of symptoms assessment, it is often difficult to rely upon them in this population and tools conventionally used in patients with stable angina to guide revascularization (i.e., fractional flow reserve) are still not well validated and widely used in the setting of severe aortic stenosis. Hence, it is reasonable to percutaneously revascularize ostial or

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Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve

Cited by 32 publications

References 28 publications

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation

Current Key Issues in Transcatheter Aortic Valve Replacement Undergoing a Paradigm Shift

Revascularizing coronary artery disease in patients undergoing transcatheter aortic valve implantation

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