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Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR)
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Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR)

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 6263

Special Issue Editors

Dr. Guillem Muntané-Carol

E-Mail Website
Guest Editor
1. Interventional Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
2. BIOHEART Cardiovascular Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain
Interests: interventional cardiology; structural heart disease; transcatheter mitral valve repair; transcatehter tricuspid valve interventions; coronary percutaneous intervention; high-risk PCI; bifurcation PCI; chronic total oclusion PCI
Dr. Joan Antoni Gómez-Hospital

E-Mail Website
Guest Editor
1. Interventional Cardiology Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
2. BIOHEART Cardiovascular Diseases Group, Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
Interests: interventional cardiology; structural heart disease; transcatheter mitral valve repair; transcatehter tricuspid valve interventions; coronary percutaneous intervention; high-risk PCI; percutaneous mechanical support in high-risk PCI percutaneous mechanical support in high-risk PCI

Special Issue Information

Dear Colleagues,

Transcatheter aortic replacement (TAVR) has revolutionized the treatment of aortic stenosis. Nowadays, TAVR using the transfemoral approach is a well-established therapeutic option in elderly patients with aortic stenosis, irrespective of their surgical risk. Recently, successive improvements in transcatheter heart valve systems and growing experience in the field have led to a minimalist procedure, with a progressive reduction in periprocedural complications and death. However, there is still room for improvement in several aspects of the TAVR procedure. First, conduction disturbances such as high-degree atrioventricular block requiring permanent pacemaker implantation and new-onset left bundle branch block remain the most frequent drawback of the procedure. Additionally, the risk of paravalvular leak remains higher in TAVR compared to surgical aortic valve replacement. Other important aspects include periprocedural stroke, management of coronary artery disease before and after the procedure, choice of intervention in patients with small aortic annulus, antithrombotic treatment after the procedure, and very long-term durability (>5 years). Overcoming these challenges will represent a definitive shift in favoring TAVI as the widespread treatment of severe aortic stenosis.

This Special Issue will address several unresolved questions, including those involving clinical and procedural aspects, to improve clinical outcomes in this context. Both original research articles and state-of-the-art reviews are welcome.

Dr. Guillem Muntané-Carol
Dr. Joan Antoni Gómez-Hospital
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement
  • aortic valve stenosis
  • conduction disturbances
  • stroke
  • coronary artery disease

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Published Papers (3 papers)

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Research

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8 pages, 461 KiB  
Article
Transcatheter Aortic Valve Replacement for Bicuspid vs. Tricuspid Aortic Stenosis among Patients at Low Surgical Risk in China: From the Multicenter National NTCVR Database
by Nanchao Hong, Wenzhi Pan, Xianbao Liu, Daxin Zhou, Jianan Wang and Junbo Ge
J. Clin. Med. 2023, 12(1), 387; https://doi.org/10.3390/jcm12010387 - 3 Jan 2023
Cited by 2 | Viewed by 2284
Abstract
Background: This study aims to compare the outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable valves for bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) stenosis patients who are at low surgical risk. Methods: Participants were enrolled from 36 centers in [...] Read more.
Background: This study aims to compare the outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable valves for bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) stenosis patients who are at low surgical risk. Methods: Participants were enrolled from 36 centers in China between January 2017 and December 2021. The primary endpoint event was all-cause mortality and all stroke at 30 days. Results: Among 389 patients at low surgical risk that underwent TAVR, 229 patients were BAV stenosis (mean age, 72.9 years; 65.1% men). There was no significant difference in the rate of all-cause death between two populations at 30 days. However, the rate of all stroke was significantly higher in the BAV group at 30 days (3.3% vs. 0%; odds ratio (OR), 0.97 (95% confidence interval (CI), 0.94 to 0.99); p = 0.044). By multivariate logistic regression analysis, trans-carotid access was associated with a higher all stroke rate at 30 days (OR, 29.20 (95% CI, 3.97 to 215.1); p = 0.001). Conclusions: In this national registry-based study, patients treated for BAV vs. TAV stenosis had no significant difference in all-cause mortality at 30 days, but trans-carotid access was associated with a higher all stroke rate after TAVR at 30 days. Full article
(This article belongs to the Special Issue Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR))
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Review

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11 pages, 4357 KiB  
Review
The Management of Coronary Artery Disease in TAVR Patients
by Laurent Faroux, Aurélien Villecourt and Damien Metz
J. Clin. Med. 2023, 12(22), 7126; https://doi.org/10.3390/jcm12227126 - 16 Nov 2023
Cited by 2 | Viewed by 1277
Abstract
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, [...] Read more.
About half of the transcatheter aortic valve replacement (TAVR) recipients exhibit some degree of coronary artery disease (CAD), and controversial results have been reported regarding the impact of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on the use of both cardiac computed tomography angiography and the functional invasive assessment of coronary lesions whether by FFR or iFR in the work-up pre-TAVR. Despite mitigated available data, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Additionally, scarce data exists on the incidence, characteristics and management of coronary events post-TAVR, and increasing interest exists on the potential coronary access challenges in patients requiring coronary angiography/intervention post-TAVR. This review provides an updated overview of the knowledge of CAD in TAVR recipients, focusing on its prevalence, clinical impact, pre- and post-procedural evaluation and management. Full article
(This article belongs to the Special Issue Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR))
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Other

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10 pages, 527 KiB  
Brief Report
One-Year Outcomes after Myval Implantation in Patients with Bicuspid Aortic Valve Stenosis—A Multicentre Real-World Experience
by Ahmed Elkoumy, John Jose, Christian Juhl Terkelsen, Henrik Nissen, Sengottuvelu Gunasekaran, Mahmoud Abdelshafy, Ashok Seth, Hesham Elzomor, Sreenivas Kumar, Francesco Bedogni, Alfonso Ielasi, Shahram Arsang-Jang, Santosh Kumar Dora, Sharad Chandra, Keyur Parikh, Daniel Unic, Andreas Baumbach, Patrick Serruys and Osama Soliman
J. Clin. Med. 2023, 12(6), 2398; https://doi.org/10.3390/jcm12062398 - 20 Mar 2023
Cited by 4 | Viewed by 2029
Abstract
Background: Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with [...] Read more.
Background: Bicuspid aortic valve (BAV) affects approximately 1.5% of the general population and is seen in nearly 50% of candidates for aortic valve replacement (AVR). Despite increasingly utilised transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) patients, its use among patients with severe bicuspid AS is limited as BAV is a heterogeneous disease associated with multiple and complex anatomical challenges. Aim: To investigate the one-year outcomes of TAVI using the balloon-expandable Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd., Vapi, India) in patients with severe bicuspid AS. Methods and results: We collected data from consecutive patients with bicuspid AS who underwent TAVI with the Myval THV and had at least one-year follow-up. Baseline characteristics, procedural, and 30-day echocardiographic and clinical outcomes were collected. Sixty-two patients were included in the study. The median age was 72 [66.3, 77.0] years, 45 (72.6%) were males, and the mean STS PROM score was 3.2 ± 2.2%. All TAVI procedures were performed via the transfemoral route. The median follow-up duration was 13.5 [12.2, 18.3] months; all-cause mortality was reported in 7 (11.3%) patients and cardiovascular hospitalisation in 6 (10.6%) patients. All-stroke was reported in 2 (3.2%), permanent pacemaker implantation 5 (8.3%), and myocardial infarction 1 (1.6%) patients. The echocardiographic assessment revealed a mean pressure gradient of 10 [8, 16.5] mmHg, effective orifice area 1.7 [1.4, 1.9] cm2, moderate AR in 1 (2%), mild AR in 14 (27%), and none/trace AR in 37 (71%). In total, 1 patient was diagnosed with valve thrombosis (2.1%), Stage II (moderate) haemodynamic deterioration was seen in 3 (6.4%), and stage III (severe) haemodynamic deterioration in 1 (2.1%) patient. Conclusions: TAVI with the Myval THV in selected BAV anatomy is associated with favourable one-year hemodynamic and clinical outcomes. Full article
(This article belongs to the Special Issue Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR))
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