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Recent Advances in Transcatheter Aortic Valve Replacement
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Recent Advances in Transcatheter Aortic Valve Replacement

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

Deadline for manuscript submissions: closed (10 September 2024) | Viewed by 5928

Special Issue Editors

Dr. Maciej Dąbrowski

E-Mail Website
Guest Editor
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
Interests: coronary angioplasty; aortic stenosis; transcatheter aortic valve implantation; hypertrophic cardiomyopathy
Dr. Anna Olasińska-Wiśniewska

E-Mail Website
Guest Editor
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-848 Poznan, Poland
Interests: aortic stenosis; transcatheter aortic valve implantation; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Transcatheter aortic valve replacement (TAVI) has evolved rapidly since the first procedure in 2002. Currently, TAVI is the recommended method of treatment for patients with severe aortic stenosis with moderate to high surgical risk, in addition to some selected low-risk patients. Diagnostic modalities support the proper qualification for the procedure. Modifications of the technique, bioprostheses and delivery systems enable operators to perform the procedure relatively safely, even in particularly difficult clinical scenarios. Nevertheless, several troublesome issues may occur during or after the procedure. The aim of this Special Issue is to share experiences in pre-procedural planning, procedural techniques and post-procedural outcomes in order to broaden the knowledge on TAVI performance and improve TAVI team skills. 

We invite authors to share their valuable opinions and the results of their research as original or review papers. We would be very grateful for your outstanding contribution to the further development of TAVI.

Dr. Maciej Dąbrowski
Dr. Anna Olasińska-Wiśniewska
Guest Editors

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Keywords

  • aortic stenosis
  • transcatheter
  • bioprosthesis
  • TAVI
  • Transcatheter aortic valve replacement

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Published Papers (5 papers)

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12 pages, 940 KiB  
Article
Combined Computed Coronary Tomography Angiography and Transcatheter Aortic Valve Implantation (TAVI) Planning Computed Tomography Reliably Detects Relevant Coronary Artery Disease Pre-TAVI
by Dominik Felbel, Christoph Buck, Natalie Riedel, Michael Paukovitsch, Tilman Stephan, Marvin Krohn-Grimberghe, Johannes Mörike, Birgid Gonska, Christoph Panknin, Christopher Kloth, Meinrad Beer, Wolfgang Rottbauer and Dominik Buckert
J. Clin. Med. 2024, 13(16), 4885; https://doi.org/10.3390/jcm13164885 - 19 Aug 2024
Viewed by 802
Abstract
Background: Before surgical or transcatheter aortic valve implantation (TAVI), coronary status evaluation is required. The role of combined computed coronary tomography angiography (cCTA) and TAVI planning CT in this context is not yet well elucidated. This study assessed whether relevant proximal coronary disease [...] Read more.
Background: Before surgical or transcatheter aortic valve implantation (TAVI), coronary status evaluation is required. The role of combined computed coronary tomography angiography (cCTA) and TAVI planning CT in this context is not yet well elucidated. This study assessed whether relevant proximal coronary disease requiring coronary revascularization can be safely detected by combined cCTA and TAVI planning CT, including CT-derived fractional flow reserve (FFR) calculation in patients with severe aortic stenosis. Methods: This study analyzed patients with successful cCTA combined with TAVI planning CT using a 128-slice dual-source scanner. The detection via cCTA of relevant left main stem stenosis (>50%) or proximal coronary artery stenosis (>70%) was compared to invasive coronary angiography (ICA). Results: This study comprised 101 consecutive TAVI patients with a median age of 83 [77–86] years, a median STS score of 3.7 [2.4–6.1] and 54% of whom had known coronary artery disease. Of 15 patients with relevant coronary stenoses, 14 (93.3%) were detected with cCTA, while false positive results were found in 25 patients. Only in patients with previous percutaneous coronary stent implantation (PCI) were false positive rates (11/29) increased. In the subgroup without previous PCI, an improved classification performance of 87.5%, being mainly due to 11.1% false positive classifications, led to a negative predictive value of 98.5%. Conclusions: Combined cCTA and CT-FFR with TAVI planning CT via state-of-the-art scanners and protocols as a one-stop shop can replace routine ICA in patients prior to TAVI due to its safe detection of relevant coronary artery stenosis, although diagnostic performance of cCTA is only reduced in patients with coronary stents. Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement)
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12 pages, 1278 KiB  
Article
Short-Term Changes in Arterial Stiffness Measured by 2D Speckle Tracking in Patients Undergoing Transcatheter Aortic Valve Implantation
by Leonie Arnold, Nikolaus Alexander Haas, André Jakob, Julius Fischer, Steffen Massberg, Simon Deseive and Felix Sebastian Oberhoffer
J. Clin. Med. 2024, 13(1), 222; https://doi.org/10.3390/jcm13010222 - 30 Dec 2023
Viewed by 968
Abstract
Arterial stiffness has received increasing interest as a cardiovascular marker in patients with aortic valve stenosis (AS). So far, studies on the impact of aortic valve replacement (AVR) on arterial stiffness have been equivocal. Two-dimensional speckle tracking (2DST) is a novel, non-invasive method [...] Read more.
Arterial stiffness has received increasing interest as a cardiovascular marker in patients with aortic valve stenosis (AS). So far, studies on the impact of aortic valve replacement (AVR) on arterial stiffness have been equivocal. Two-dimensional speckle tracking (2DST) is a novel, non-invasive method to measure the motion of the vessel wall. In this prospective observational study, we aimed to assess the change in arterial stiffness of the common carotid artery (CCA) measured by 2DST in patients undergoing transcatheter aortic valve implantation (TAVI). A total of 47 patients were included in the study (age 80.04 ± 6.065 years). Peak circumferential strain (CS) was significantly improved after TAVI (4.50 ± 2.292 vs. 5.12 ± 2.958, p = 0.012), as was the peak strain rate (CSR) (0.85 ± 0.567 vs. 1.35 ± 0.710, p = 0.002). Body mass index (BMI), mean arterial pressure (MAP) and hemodynamic parameters were associated with this change. 2DST results did not correlate with aortic pulse wave velocity (aPWV) or augmentation index normalized to heart rate (AIx@75), suggesting a distinct difference between arterial stiffness of the CCA and other stiffness parameters. 2DST seems to be a promising new tool to assess arterial stiffness in TAVI patients. Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement)
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11 pages, 1082 KiB  
Article
Assessing the Novel Myval Balloon-Expandable Valve with the Evolut Valve: A Propensity-Matched Study
by Jonathan Halim, Maxim Rooijakkers, Peter den Heijer, Milad El Haddad, Ben van den Branden, Jeroen Vos, Bas Schölzel, Martijn Meuwissen, Menno van Gameren, Saloua El Messaoudi, Niels van Royen and Sander IJsselmuiden
J. Clin. Med. 2023, 12(13), 4213; https://doi.org/10.3390/jcm12134213 - 22 Jun 2023
Cited by 4 | Viewed by 1765
Abstract
Background: The Myval balloon-expandable (BE) valve has shown encouraging early clinical data in terms of safety and efficacy. Comparative data with other well-established contemporary valves are nonetheless still scarce. This study aims to compare the performance of the Myval BE valve with the [...] Read more.
Background: The Myval balloon-expandable (BE) valve has shown encouraging early clinical data in terms of safety and efficacy. Comparative data with other well-established contemporary valves are nonetheless still scarce. This study aims to compare the performance of the Myval BE valve with the Evolut self-expanding (SE) valve. Methods: In this retrospective single-center study, 223 patients with symptomatic severe aortic stenosis (AS) were included and treated with the Myval BE valve (n = 120) or with the Evolut SE valve (n = 103). Then, 91 pairs were compared after matching. Clinical outcomes were evaluated at 30 days and 1 year. Echocardiographic follow-up was performed at 30 days. Results: Procedural complications were rare in both groups. At the 30-day follow-up, no significant difference in cardiac death (Myval: 1% vs. Evolut: 2%, p = 0.56), stroke (2% vs. 4%, p = 0.41) and myocardial infarction (1% vs. 3%, p = 0.31) was observed. A permanent pacemaker implantation (PPI) was significantly less needed in the Myval group (4% vs. 15%, p = 0.01). At 1 year, cardiac death (2% vs. 4%, p = 0.41) and the stroke rate (7% vs. 5%, p = 0.76) were similar. Moderate–severe paravalvular leakage (PVL) was also comparable in both groups (1% vs. 4%, p = 0.17). Conclusion: Safety and efficacy outcomes were comparable between the two valves, except for a higher PPI rate for the Evolut SE valve. Up to 1-year follow-up, clinical outcomes showed acceptable rates of stroke and cardiac death with both valves. Valve hemodynamics were excellent with a low rate of moderate–severe PVL in both groups. Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement)
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7 pages, 513 KiB  
Case Report
CT-Derived Patient-Specific Computer Simulation of the Novel Self-Expanding Evolut FX Implantation: A Case Series
by Romy R. M. J. J. Hegeman, Simon E. van Putten, Leo Timmers, Benno J. W. M. Rensing, Uday Sonker, Severin Laengle, Martin Andreas, Martin J. Swaans, Jurriën M. ten Berg and Patrick Klein
J. Clin. Med. 2024, 13(20), 6212; https://doi.org/10.3390/jcm13206212 - 18 Oct 2024
Viewed by 688
Abstract
Background/Objectives: Paravalvular leak and permanent pacemaker implantation remain relevant issues after transcatheter aortic valve implantation (TAVI). Novel device development as well as adequate preprocedural device selection can contribute to optimal outcomes. Methods: Computed tomography-based patient-specific computer anatomical analysis and simulation were [...] Read more.
Background/Objectives: Paravalvular leak and permanent pacemaker implantation remain relevant issues after transcatheter aortic valve implantation (TAVI). Novel device development as well as adequate preprocedural device selection can contribute to optimal outcomes. Methods: Computed tomography-based patient-specific computer anatomical analysis and simulation were used in addition to standard preprocedural preparation in three of the first Evolut FX cases in our center. Procedural and follow-up echocardiographic outcomes are presented. Results: Computed tomography-based computer simulation of Evolut FX resulted in implantation of a different size in one of three cases. In three cases of severe aortic valve stenosis, procedural as well as follow-up outcomes were satisfactory and in line with the simulated results of the chosen strategy. Conclusions: Preprocedural patient-specific computer simulation predicts and guides decision-making in TAVI with the Evolut FX platform. The combination of advanced preprocedural technology and novel technologies continues to contribute to the optimization of TAVI outcomes. Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement)
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10 pages, 5312 KiB  
Case Report
Trans-Brachial TAVI in a Patient with Aortic Isthmus Stenosis: A Case Report
by Mohammed Saad, Abdelrahman Elhakim, Rene Rusch, Rouven Berndt, Bernd Panholzer, Georg Lutter and Derk Frank
J. Clin. Med. 2024, 13(2), 308; https://doi.org/10.3390/jcm13020308 - 5 Jan 2024
Cited by 1 | Viewed by 1028
Abstract
Background: TAVI indications expand not only to low-risk patients but also to patients with a more complex anatomy and comorbidities. Transfemoral retrograde access is recognized as the first preferred approach according to the current guidelines. However, this approach is not suitable in up [...] Read more.
Background: TAVI indications expand not only to low-risk patients but also to patients with a more complex anatomy and comorbidities. Transfemoral retrograde access is recognized as the first preferred approach according to the current guidelines. However, this approach is not suitable in up to 10–15% of patients, for whom an alternative non-femoral access route is required. Case Presentation: An 83-year-old male patient with known aortic isthmus stenosis presented with severe symptomatic aortic stenosis. Computed tomography revealed a subtotal isthmus stenosis, directly after left subclavian artery origin, with many collaterals extending toward the axillary and subclavian arteries. Duplex ultrasound verified the proximal diameter of the left brachial artery to be 5.5 mm. A successful surgical cutdown trans-brachial TAVI with an Evolut prosthetic valve with a size of 29 mm was performed. On the fourth postoperative day, the patient was discharged, and the three-month follow-up was uneventful. Conclusion: In patients with aortic isthmus stenosis, the brachial artery could be a feasible alternative, as a less invasive access site, which can be determined after careful assessment of the vessel diameter. More data are required to evaluate the safety and efficacy of this access route and to achieve more technical improvements to increase operator familiarity with it. Full article
(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement)
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