TAVI in 2022: Remaining issues and future direction.

Details

Serval ID
serval:BIB_4682F7EEA91D
Type
Article: article from journal or magazin.
Collection
Publications
Title
TAVI in 2022: Remaining issues and future direction.
Journal
Archives of cardiovascular diseases
Author(s)
Webb J.G., Blanke P., Meier D., Sathananthan J., Lauck S., Chatfield A.G., Jelisejevas J., Wood D.A., Akodad M.
ISSN
1875-2128 (Electronic)
ISSN-L
1875-2128
Publication state
Published
Issued date
04/2022
Peer-reviewed
Oui
Volume
115
Number
4
Pages
235-242
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Since the first-in-human procedure in 2002, transcatheter aortic valve implantation (TAVI) has become a well-established therapeutic option for severe aortic stenosis, and is offered increasingly to patients at lower surgical risk, who are typically younger. Increasing lifespan carries concerns that "minor" complications that may have little impact in elderly patients could have a greater long-term impact in younger patients. Issues such as mild paravalvular regurgitation, hypoattenuated leaflet thickening, atrioventricular block with need for permanent pacemaker implantation or future coronary access may have a substantial cumulative undesirable impact. Additionally, as with surgical bioprosthetic valves, transcatheter bioprosthetic valves will eventually degenerate, and may require repeat intervention. Although durability data for transcatheter heart valves (THVs) is encouraging, very late data are lacking. Redo TAVI has been shown to be feasible with acceptable outcomes in patients with failed THVs, but in some patients, anatomical or device considerations may preclude a repeatable procedure because of the risk of coronary obstruction. Various strategies for lifetime management in this lower-risk and younger population have been proposed: surgical aortic valve replacement (SAVR) first, followed by TAVI; TAVI then SAVR; TAVI then TAVI, etc. A tailored approach may be considered according to patient co-morbidities, anatomy and the relative advantages and disadvantages of the two therapies. This review offers an overview of current challenges when considering TAVI in populations at lower risk, and summarizes the different approaches that have been developed to address these concerns.
Keywords
Aged, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/adverse effects, Heart Valve Prosthesis Implantation/methods, Humans, Risk Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome, Aortic stenosis, Détérioration de la valve structurelle, Gestion de vie, Implantation percutanée de valve aortique, Lifetime management, Rétrécissement aortique, Structural valve deterioration, Transcatheter aortic valve implantation
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:56
Last modification date
24/02/2025 11:36
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