Transcatheter aortic valve implantation: technique, complications and perspectives

Abstract

Transcatheter aortic valve implantation (TAVI) has become the preferred treatment option for patients with symptomatic severe aortic stenosis who are inoperable or at high risk for surgical aortic valve replacement. TAVI has shown a clear mortality benefit compared to conservative treatment in inoperable patients, and is at least non-inferior to surgical aortic valve replacement in high-risk operable patients. Through improvements in the field of imaging, refinement in valve technologies, increasing operator and team experience and continuous valuable research, TAVI has developed rapidly in the past years and is expected to further boost in the near future. In this review, we discuss the technical and procedural aspects of TAVI, the acute and late outcomes, and highlight the current expectations and potential future development of this rapidly evolving technology.

Transcatheter Aortic Valve Replacement: A Physician-Patient's Story

“…Beginning with the first report of a TAVR in 2002, 6 more than 70,000 transcatheter valves have been implanted worldwide. 5 Evidence to date supports TAVRespecially by means of the transfemoral approach-as an alternative to SAVR in high-risk patients with severe aortic stenosis. 7 At 2-year follow-up evaluations, these 2 treatments provided similar findings with respect to mortality rate, reduction in symptoms, and improved hemodynamic performance of the valve.…”

“…A step-by-step description of what happened next is beyond the scope of this report; details of that nature, including possible complications, are available elsewhere. 4,5 Suffice it to say, everything was done in intravascular fashion under fluoroscopic guidance. An inflated balloon broke apart the stenotic leaflets of my native aortic valve, making room for the new compressed valve.…”

“…I escaped the 2 sequelae that I had feared the most, stroke and the need for a permanent pacemaker. 4,5 The sequelae that I did incur-transient ache and tenderness in my right foot and extensive pelvic bruising-were small physical prices to pay for a new aortic valve.…”

Transcatheter Aortic Valve Replacement: Alternative Access beyond the Femoral Arterial Approach

“…In patients with inadequate luminal diameters, excessive tortuosity, or severe atherosclerotic disease, an alternative access route should be considered (17,18). In this article, we review commonly used routes for alternative access in TAVR, including the subclavian artery, transaortic access, and transapical access.…”

Minimally invasive approach to calcified aortic valve replacement: Anaesthetic considerations

“…[ 2 ] Interventional cardiology and cardiosurgery units offer minimally invasive, catheter-based AVR or transcatheter aortic valve implantation (TAVI), as an alternative to AVR. [ 3 ] In general, high-risk American Society of Anesthesiologists’ (ASA physical status) III–IV patients are candidates for TAVI. [ 4 5 ] The risks and predicted mortality can be calculated using EURO score II, which is most commonly used in cardiac surgery.…”