TAVI in 2022: Remaining issues and future direction

Webb, John G.; Blanke, Philipp; Meier, David; Sathananthan, Janarthanan; Lauck, Sandra; Chatfield, Andrew G.; Jelijevas, Julius; Wood, David; Akodad, Mariama

doi:10.1016/j.acvd.2022.04.001

Cited by 27 publications

(17 citation statements)

References 43 publications

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“…Baseline right bundle branch block (RBBB) is a major electrical disturbance, independent of age or left ventricular ejection fraction, 9 increasing the risk for atrioventricular block (AVB) leading to PPI 4–8,10–16 . In contrast, preexisting LBBB was previously known not to increase the risk of post‐TAVR conduction abnormalities 8,9,15,17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…To achieve this, a good view of the aortic annulus during deployment is needed. The “cusp overlap view” isolates the NCC (one of three cusps of the aortic valve) and allows a precise view of the ID relative to the MSL, facilitating the accurate deployment of the valve 11,39 . Other preventive measures include avoiding oversizing and aggressive balloon valvuloplasty, 6,7,39 and careful THV selection (e.g., SEV vs. BEV) based on individual patient profile 6,39 .…”

Section: Discussionmentioning

confidence: 99%

“…Baseline right bundle branch block (RBBB) is a major electrical disturbance, independent of age or left ventricular ejection fraction, 9 increasing the risk for atrioventricular block (AVB) leading to PPI. [4][5][6][7][8][10][11][12][13][14][15][16] In contrast, preexisting LBBB was previously known not to increase the risk of post-TAVR conduction abnormalities. 8,9,15,17,18 However, a recent meta-analysis found that baseline LBBB is associated with an increased incidence of PPI (odds ratio…”

Section: Preexisting Conduction Abnormalitiesmentioning

confidence: 99%

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Post‐TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

Ghazal,

Garabedian,

Sawaya

et al. 2024

Cardiovasc electrophysiol

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Transcatheter aortic valve replacement (TAVR) often leads to conduction abnormalities, necessitating pacemaker implantation. This review of 38 meta‐analyses identified preexisting right bundle branch block (RBBB), LAHB, and new‐onset left bundle branch block as key risk factors, with a higher PPM risk in male and older patients. Procedural factors like transfemoral access and self‐expandable valves also increase this risk. Prevention focuses on tailoring TAVR to individual electrophysiological and anatomical profiles. However, there's a lack of consensus in managing these conduction disturbances post‐TAVR, highlighting the need for further research and standardized treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Baseline right bundle branch block (RBBB) is a major electrical disturbance, independent of age or left ventricular ejection fraction, 9 increasing the risk for atrioventricular block (AVB) leading to PPI. [4][5][6][7][8][10][11][12][13][14][15][16] In contrast, preexisting LBBB was previously known not to increase the risk of post-TAVR conduction abnormalities. 8,9,15,17,18 However, a recent meta-analysis found that baseline LBBB is associated with an increased incidence of PPI (odds ratio…”

Section: Preexisting Conduction Abnormalitiesmentioning

confidence: 99%

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Post‐TAVR conduction abnormalities leading to permanent pacemaker implantation: Risk factors, prevention, and management

Ghazal,

Garabedian,

Sawaya

et al. 2024

Cardiovasc electrophysiol

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“…The TAVI procedure involves several short dangerous episodes, including extreme hypotension and global ischemia (rapid ventricular pacing, balloon valvuloplasty, valve implantation), coronary embolism, and some degree of myocardial tissue compression (balloon and valve prosthesis), which are all potential causes of myocardial injury. Patients also can die from multiorgan failure, major stroke, pulmonary embolism, heart failure, left ventricle perforation, or cardiogenic shock [ 61 ]. Thus, we further evaluated the effect of LA and GA anesthesia strategies on TAVI-related complications, and the results indicated that the LA group had lower rates of MI [OR = 0.86, 95% CI (0.51, 1.47), p = 0.59], shock [OR = 0.92, 95% CI (0.70, 1.22), p = 0.58] and cerebrovascular events [OR = 0.91, 95% CI (0.69, 1.21), p = 0.52] than the GA group, but the differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Wang

Liu

Gao

et al. 2023

JCM

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It remains controversial to choose anesthesia for transcatheter aortic valve implantation (TAVI). A meta-analysis of cohort studies was conducted to assess the efficacy and safety of local anesthesia (LA) compared to general anesthesia (GA) in TAVI. All relevant studies published from Jan 1, 2002, to Jun 31, 2022, were searched in Ovid, PubMed, Embase, Web of Science, and Cochrane Library. A total of 34 studies involving 23,480 patients were included in the meta-analysis. TAVI with LA was associated with a significant reduction in hospital stay [WMD = −2.48, 95%CI (−2.80, −2.16), P < 0.00001], operative [WMD = −12.25, 95%CI (−13.73, −10.78), p < 0.00001] and fluoroscopy time [WMD = −3.30, 95% CI (−5.40, −1.19), p = 0.002], and an increased risk of acute kidney injury [OR = 1.31, 95% CI (1.01, 1.69), p = 0.04] and a reduced incidence of major bleeding [OR = 0.59, 95% CI (0.46, 0.75), p < 0.0001] and the use of cardiovascular drugs [OR = 0.17, 95% CI (0.05, 0.57), p = 0.004]. No differences were found between LA and GA for 30-day mortality, procedural success rate, myocardial infarction, permanent pacemaker implantation, paravalvular leak, shock, and cerebrovascular events. Overall, 4.4% of LA converted to GA. Based on current evidence, our results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates in patients undergoing TAVI but led to increased acute kidney injury rates. Further studies and randomized trials are required to verify the presented findings and to identify patients who might benefit from LA.

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“…Das Verfahren ist in den letzten Jahren jedoch zunehmend auf jüngere Patienten mit mittlerem und geringem Risikoprofil ausgedehnt worden [5]. Aufgrund der höheren Lebenserwartung in dieser Patientengruppe bekommen methodische Komplikationen des TAVI-Verfahrens und der verwendeten Prothesen, die sich auf Hochrisikopatienten prognostisch wenig oder gar nicht auswirken, einen viel höheren klinischen Stellenwert.…”

Section: Transkathetergestützter Klappenersatz (Tavi)unclassified