Indications for transcatheter aortic valve implantation – now and next?

Abstract

Aortic stenosis (AS) is the most common valvular pathology and its prevalence is expected to increase rapidly in coming decades as a consequence of the increasingly elderly population. Without treatment, severe symptomatic AS has a very poor prognosis with a mortality of 50% at two years. Whilst surgical aortic valve replacement is the gold standard treatment, a significant minority of patients are deemed inoperable and declined surgery due to prohibitively high risk. The advent of transcatheter aortic valve implantation (TAVI) has revolutionised their treatment. In this review, we discuss current indications for TAVI, other applications of this technology and future indications.

Population-specific material properties of the implantation site for transcatheter aortic valve replacement finite element simulations

“…TAVR is an ideal setting to advance the field of patient-specific modelling, as the substrate of the TAVR population, with highly calcified implantation sites, present fewer variations in terms of mechanical properties compared to other cardiovascular sites or patient groups ( Pham et al, 2017 ). TAVR outcomes depend on appropriate patient assessment ( Kalogeras, 2012 , Ruparelia and Prendergast, 2015 ), and complications such as paravalvular leak (PVL) ( Azadani et al, 2009 , Tamburino et al, 2011 ) and onset of conduction abnormalities leading to permanent pacemaker implantation ( Binder et al, 2013 , Bleiziffer et al, 2010 ) remain common, therefore warranting a patient-specific computational approach to enhance patient selection ( Schoenhagen et al, 2011 , Taylor and Figueroa, 2009 , Vy et al, 2015 ). A few patient-specific computational models are already available in the literature for TAVR ( Bianchi et al, 2016 , Capelli et al, 2012 , Gunning et al, 2014 , Morganti et al, 2014 , Sirois et al, 2011 , Sturla et al, 2016 , Wang et al, 2015 , Wu et al, 2016 ), but choice of the material parameters for the implantation site remains open ( Tseng et al, 2013 ).…”