Abstract
Transcatheter aortic valve replacement (TAVR) constitutes a relatively new treatment
option for the patients with severe symptomatic aortic stenosis. Evidence from registries
and randomized control trials has underscored the value of this treatment in inoperable
and high risk populations, while new developments in valve technology and TAVR enabling
devices have reduced the risk of complications, simplified the procedure, and broadened
the applications of this therapy. The initial promising clinical results and the potential
of an effective less invasive treatment of aortic stenosis has not only created high
expectations but also the need to address the pitfalls of TAVR technology. The evolving
knowledge concerning the groups of patients who would benefit from this treatment,
the limited long term follow-up data, the concerns about devices' long term durability,
and the severity of complications remain important caveats which restrict the widespread
clinical adoption of TAVR. The aim of this review article is to present the recent
advances, highlight the limitations of TAVR technology, and discuss the future perspectives
in this rapidly evolving field.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.Circulation. 2002; 106: 3006-3008
- Keynote address-EuroPCR 2008, Barcelona, May 14th, 2008. Transcatheter aortic valve implantation: state of the art.EuroIntervention. 2009; 4: 558-565
- Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2012; 33: 2451-2496
- Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.N Engl J Med. 2010; 363: 1597-1607
- Two-year outcomes after transcatheter or surgical aortic-valve replacement.N Engl J Med. 2012; 366: 1686-1695
- Transcatheter versus surgical aortic-valve replacement in high-risk patients.N Engl J Med. 2011; 364: 2187-2198
- A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial.EuroIntervention. 2012; 8: 383-389
- One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve.Circulation. 2011; 124: 425-433
- Treatment of high risk aortic stenosis patients with transcatheter Medtronic CoreValve implantation: results from the international multi-center ADVANCE study.J Am Coll Cardiol. 2012; 59
- Improvements in transcatheter aortic valve implantation outcomes in lower surgical risk patients: a glimpse into the future.J Am Coll Cardiol. 2012; 59: 280-287
- Transcatheter aortic valve implantation: new developments and upcoming clinical trials.EuroIntervention. 2012; 8: 617-627
- Transcatheter aortic valve implantation: durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort.Circulation. 2010; 122: 1319-1327
- 2-year follow-up of patients undergoing transcatheter aortic valve implantation using a self-expanding valve prosthesis.J Am Coll Cardiol. 2011; 57: 1650-1657
- Prosthetic heart valve.Circulation. 2011; 123: 2602-2605
- Risk of reoperation for aortic bioprosthesis dysfunction.J Heart Valve Dis. 2009; 18: 256-261
- Reoperative surgery for degenerated aortic bioprostheses: predictors for emergency surgery and reoperative mortality.Eur J Cardiothorac Surg. 2000; 17: 134-139
- Repeat heart valve surgery: risk factors for operative mortality.J Thorac Cardiovasc Surg. 2001; 122: 913-918
- Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry.Circulation. 2012; 126: 2335-2344
- Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 2).JACC Cardiovasc Interv. 2011; 4: 733-742
- Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves.Circulation. 2010; 121: 1848-1857
- Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 1).JACC Cardiovasc Interv. 2011; 4: 721-732
- Long-term outcomes after transcatheter aortic valve implantation: insights on prognostic factors and valve durability from the Canadian multicenter experience.J Am Coll Cardiol. 2012; 60: 1864-1875
- Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation.JACC Cardiovasc Interv. 2012; 5: 489-496
- Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI).Eur Heart J. 2013; 34: 684-692
- The SURTAVI model: proposal for a pragmatic risk stratification for patients with severe aortic stenosis.EuroIntervention. 2012; 8: 258-266
- Patient selection for transcatheter aortic valve implantation: patient risk profile and anatomical selection criteria.Arch Cardiovasc Dis. 2012; 105: 165-173
- Frequency of conduction abnormalities after transcatheter aortic valve implantation with the Medtronic-CoreValve and the effect on left ventricular ejection fraction.Am J Cardiol. 2011; 107: 285-289
- Acute left main obstructions following TAVI.EuroIntervention. 2010; 6: 100-105
- Aortic regurgitation index defines severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation.J Am Coll Cardiol. 2012; 59: 1134-1141
- Mechanisms and prediction of aortic regurgitation after TAVI.EuroIntervention. 2012; 8: Q18-Q20
- Transcatheter aortic valve replacement with the St. Jude Medical Portico valve: first-in-human experience.J Am Coll Cardiol. 2012; 60: 581-586
- Medtronic CoreValve evolut valve.EuroIntervention. 2012; 8: Q94-Q96
- Transapical aortic valve implantation using a new self-expandable bioprosthesis (ACURATE TA): 6-month outcomes.Eur J Cardiothorac Surg. 2013; 43: 52-56
- Transapical transcatheter aortic valve implantation using the JenaValve system: acute and 30-day results of the multicentre CE-mark study.Eur J Cardiothorac Surg. 2012; 41: e131-e138
- Transapical aortic valve implantation with a self-expanding anatomically oriented valve.Eur Heart J. 2011; 32: 878-887
- Heart leaflet technology.in: 23rd Annual Scientific Symposium of Transcatheter Cardiovascular Therapeutics San Francisco California. November 7–11, 2011
- Midterm stability and hemodynamic performance of a transfemorally implantable nonmetallic, retrievable, and repositionable aortic valve in patients with severe aortic stenosis. Up to 2-year follow-up of the direct-flow medical valve: a pilot study.Circ Cardiovasc Interv. 2011; 4: 595-601
- Repositionable percutaneous replacement of a stenotic aortic valve through implantation of the Lotus valve system: discharge/7-day outcome in the REPRISE I study.EuroPCR, Paris, FranceMay 15–18, 2012
- Nanotechnology in cardiovascular medicine.Catheter Cardiovasc Interv. 2007; 69: 643-654
- Smart materials applications for pediatric cardiovascular devices.Pediatr Res. 2008; 63: 552-558
- Minimally-invasive implantation of living tissue engineered heart valves: a comprehensive approach from autologous vascular cells to stem cells.J Am Coll Cardiol. 2010; 56: 510-520
- Injectable living marrow stromal cell-based autologous tissue engineered heart valves: first experiences with a one-step intervention in primates.Eur Heart J. 2011; 32: 2830-2840
- Stem cell-based transcatheter aortic valve implantation: first experiences in a pre-clinical model.JACC Cardiovasc Interv. 2012; 5: 874-883
- Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve.Circulation. 2010; 122: 62-69
- Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes.EuroIntervention. 2012; 8: 62-70
- First-in-man experience with a new embolic deflection device in transcatheter aortic valve interventions.EuroIntervention. 2012; 8: 51-56
- First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation.EuroIntervention. 2012; 8: 43-50
- Early clinical experience using the embrella deflector.in: 23rd Annual Scientific Symposium of Transcatheter Cardiovascular Therapeutics San Francisco California. November 7-11, 2011
- Anatomo-pathological analysis after CoreValve revalving system implantation.EuroIntervention. 2009; 5: 78-85
- Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol. 2011; 108: 1772-1776
- Incidence, predictive factors, and prognostic value of new-onset atrial fibrillation following transcatheter aortic valve implantation.J Am Coll Cardiol. 2012; 59: 178-188
- Frequency and causes of stroke during or after transcatheter aortic valve implantation.Am J Cardiol. 2012; 109: 1637-1643
- Timing, predictive factors, and prognostic value of cerebrovascular events in a large cohort of patients undergoing transcatheter aortic valve implantation.Circulation. 2012; 126: 3041-3053
- Clinical and prognostic implications of existing and new-onset atrial fibrillation in patients undergoing transcatheter aortic valve implantation.J Thromb Thrombolysis. 2012; ([Dec 27])
- Periprocedural and short-term outcomes of transfemoral transcatheter aortic valve implantation with the Sapien XT as compared with the Edwards Sapien valve.JACC Cardiovasc Interv. 2011; 4: 743-750
- Balloo-expandable sheath for borderline vascular access in transfemoral TAVI.EuroIntervention. 2012; 8: Q125
- Clinical outcomes using a new crossover balloon occlusion technique for percutaneous closure after transfemoral aortic valve implantation.JACC Cardiovasc Interv. 2011; 4: 861-867
- Suture-mediated arterial access site closure after transfemoral aortic valve implantation.Catheter Cardiovasc Interv. 2013; 81: E139-E150
- Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence.JACC Cardiovasc Interv. 2009; 2: 821-827
- Aortic annulus dimensions and leaflet calcification from contrast MSCT predict the need for balloon post-dilatation after TAVI with the Medtronic CoreValve prosthesis.EuroIntervention. 2011; 7: 564-572
- Aortic annulus sizing: echocardiographic versus computed tomography derived measurements in comparison with direct surgical sizing.Eur J Cardiothorac Surg. 2012; 42: 627-633
- Impact of CT-guided valve sizing on post-procedural aortic regurgitation in transcatheter aortic valve implantation.EuroIntervention. 2012; 8: 546-555
- Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study.J Cardiovasc Magn Reson. 2011; 13: 82
- Impact of three-dimensional transesophageal echocardiography on prosthesis sizing for transcatheter aortic valve implantation.Catheter Cardiovasc Interv. 2012; 80: 956-963
- Rotational angiography for preinterventional imaging in transcatheter aortic valve implantation.Catheter Cardiovasc Interv. 2012; 79: 756-765
- Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography: validation of a Prototype Software.Catheter Cardiovasc Interv. 2010; 76: 602-607
- The 3mensio Valves multimodality workstation.EuroIntervention. 2012; 7: 1464-1469
- Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements — utility of three-dimensional rotational angiography.EuroIntervention. 2012; 8: 538-545
- Prediction of optimal deployment projection for transcatheter aortic valve replacement: angiographic 3-dimensional reconstruction of the aortic root versus multidetector computed tomography.Circ Cardiovasc Interv. 2012; 5: 247-252
- Automatically segmented DynaCT: enhanced imagining during transcatheter aortic valve implantation.J Am Coll Cardiol. 2011; 58: e211
- Edwards Sapien 3 valve.EuroIntervention. 2012; 8: Q83-Q87
- Boston scientific Lotus valve.EuroIntervention. 2012; 8: Q70-Q74
- Direct Flow medical valve.EuroIntervention. 2012; 8: Q75-Q78
- JenaValve.EuroIntervention. 2012; 8: Q88-Q93
- St Jude medical Portico valve.EuroIntervention. 2012; 8: Q97-Q101
- Symetis Acurate TA valve.EuroIntervention. 2012; 8: Q102-Q109
- Edwards Centera valve.EuroIntervention. 2012; 8: Q79-Q82
- Transcatheter aortic valve replacement in patients with critical aortic stenosis: rationale, device descriptions, early clinical experiences, and perspectives.Semin Thorac Cardiovasc Surg. 2006; 18: 165-174
Article info
Publication history
Published online: April 17, 2013
Accepted:
March 17,
2013
Received in revised form:
January 9,
2013
Received:
November 9,
2012
Footnotes
☆All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
