Transcatheter Aortic Valve Implantation (TAVI) II

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 5381

Special Issue Editors

Cardiac Surgery Department, Cardiocentro Ticino Institute, Via Tesserete 48, CH-6900 Lugano, Switzerland
Interests: transcatheter heart valve procedures; minimally invasive cardiac surgery; myocardial protection; development of new transcatheter technologies; transcatheter aortic root replacement (TARR) procedures
Special Issues, Collections and Topics in MDPI journals
Fondazione C.N.R. Reg. Toscana G. Monasterio, Ospedale del Cuore, 54100 Massa, Italy
Interests: interventional cardiology; TAVI; transcatheter mitral repair; STEMI; NSTEMI; transcatheter tricuspid repair; LAA closure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Due to the success of the first edition of the Special Issue “Transcatheter Aortic Valve Implantation (TAVI)”, https://www.mdpi.com/journal/jcdd/special_issues/transcatheter_valve, we have launched a second edition.

Over the last ten years, transcatheter aortic valve implantation (TAVI) has become an important minimally invasive approach that represents an alternative to standard open-heart cardiac surgery for patients at high surgical risk and suffering from severe symptomatic aortic valve stenosis. Based on the results of the most recent clinical trials, this new technology is even additionally recommended for use in patients with an intermediate risk profile and, therefore, the population of patients potentially treatable with a TAVI device is continuing to grow in Western countries. Modern cardiac imaging, computational tools for the 3D imaging analysis of cardiac and vascular structures, and the use of fusion technologies during TAVI procedures have become important key factors for the success of TAVI procedures. Similarly, the evolution of TAVI devices has helped to improve hemodynamic results, simplifying the procedural steps and lowering the rate of post-TAVI vascular injury, paravalvular leak, and permanent pacemaker implantation. The aim of the present Special Issue is to provide a clear and modern overview on contemporary trends in TAVI and describe, with technical details and clinical data, the latest results and technologies in use during TAVI and valve-in-valve procedures. We hope that with the help of this Special Issue, modern cardiologists and cardiac surgeons involved in TAVI-dedicated heart teams can easily improve their knowledge by learning about the latest trends in TAVI as presented by experts in the field.

Prof. Dr. Enrico Ferrari
Dr. Sergio Berti
Guest Editors

Manuscript Submission Information

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Keywords

  • aortic valve
  • transcatheter aortic valve procedures
  • transcatheter devices
  • aortic valve stenosis
  • paravalvular leak
  • access sites for TAVI

Published Papers (4 papers)

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Research

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15 pages, 1594 KiB  
Article
Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement
J. Cardiovasc. Dev. Dis. 2023, 10(11), 441; https://doi.org/10.3390/jcdd10110441 - 25 Oct 2023
Viewed by 1337
Abstract
Introduction: Although transfemoral aortic valve replacement (TAVR) is a safe treatment for elderly patients with severe aortic valve stenosis, postoperative microembolism has been described. In this secondary endpoint analysis of the POST-TAVR trial, we aimed to investigate whether changes in neuron-specific enolase (NSE)—a [...] Read more.
Introduction: Although transfemoral aortic valve replacement (TAVR) is a safe treatment for elderly patients with severe aortic valve stenosis, postoperative microembolism has been described. In this secondary endpoint analysis of the POST-TAVR trial, we aimed to investigate whether changes in neuron-specific enolase (NSE)—a biomarker of neuronal damage—are associated with changes in memory function or postoperative delirium (POD). Materials and Methods: This was a prospective single-center study enrolling patients undergoing elective TAVR. Serum NSE was measured before and 24 h after TAVR. POD was diagnosed using CAM-ICU testing. Memory function was assessed before TAVR and before hospital discharge using the “Consortium to Establish a Registry for Alzheimer’s Disease” (CERAD) word list and the digit span task (DST) implemented in “∆elta-App”. Results: Subjects’ median age was 82 years (25th to 75th percentile: 77.5–85.0), 42.6% of subjects were women. CERAD scores significantly increased from pre- to post-TAVR, with p < 0.001. POD occurred in 4.4% (6/135) of subjects at median 2 days after TAVR. After TAVR, NSE increased from a median of 1.85 ng/mL (1.30–2.53) to 2.37 ng/mL (1.69–3.07), p < 0.001. The median increase in NSE was 40.4% (13.1–138.0) in patients with POD versus 17.3% (3.3–43.4) in those without POD (p = 0.17). Conclusions: Memory function improved after TAVR, likely due to learning effects, with no association to change in NSE. Patients with POD appear to have significantly higher postoperative levels of NSE compared to patients without POD after TAVR. This finding suggests that neuronal damage, as indicated by NSE elevation, may not significantly impair assessed memory function after TAVR. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
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12 pages, 1027 KiB  
Article
The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement
J. Cardiovasc. Dev. Dis. 2023, 10(5), 212; https://doi.org/10.3390/jcdd10050212 - 13 May 2023
Cited by 1 | Viewed by 1036
Abstract
Background: Frailty is highly common in older patients (pts) undergoing transcatheter aortic valve replacement (TAVR), and it is associated with poor outcomes. The selection of patients who can benefit from this procedure is necessary and challenging. The aim of the present study is [...] Read more.
Background: Frailty is highly common in older patients (pts) undergoing transcatheter aortic valve replacement (TAVR), and it is associated with poor outcomes. The selection of patients who can benefit from this procedure is necessary and challenging. The aim of the present study is to evaluate outcomes in older severe aortic valve stenosis (AS) pts, selected by a multidisciplinary approach for surgical, clinical, and geriatric risk and referred to treatment, according to frailty levels. Methods: A total of 109 pts (83 ± 5 years; females, 68%) with AS were classified by Fried’s score in pre-frail, early frail, and frail and underwent surgical aortic valve replacement SAVR/TAVR, balloon aortic valvuloplasty, or medical therapy. We evaluated geriatric, clinical, and surgical features and detected periprocedural complications. The outcome was all-cause mortality. Results: Increasing frailty was associated with the worst clinical, surgical, geriatric conditions. By using Kaplan–Meier analysis, the survival rate was higher in pre-frail and TAVR groups (p < 0.001) (median follow-up = 20 months). By using the Cox regression model, frailty (p = 0.004), heart failure (p = 0.007), EF% (p = 0.043), albumin (p = 0.018) were associated with all-cause mortality. Conclusions: According to tailored frailty management, elderly AS pts with early frailty levels seem to be the most suitable candidates for TAVR/SAVR for positive outcomes because advanced frailty would make each treatment futile or palliative. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
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Review

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10 pages, 738 KiB  
Review
Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications
J. Cardiovasc. Dev. Dis. 2023, 10(11), 469; https://doi.org/10.3390/jcdd10110469 - 19 Nov 2023
Viewed by 1186
Abstract
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due [...] Read more.
Transcatheter aortic valve implantation (TAVI) is an established alternative to surgery in patients with symptomatic severe aortic stenosis and has expanded its indications to even low-surgical-risk patients. Conduction abnormalities (CA) and permanent pacemaker (PPM) implantations remain a relatively common finding post TAVI due to the close proximity of the conduction system to the aortic root. New onset left bundle branch block (LBBB) and high-grade atrioventricular block are the most commonly reported CA post TAVI. The overall rate of PPM implantation post TAVI varies and is related to pre- and intra-procedural factors. Therefore, when screening patients for TAVI, Heart Teams should take under consideration the various anatomical, pathophysiological and procedural conditions that predispose to CA and PPM requirement after the procedure. This is particularly important as TAVI is being offered to younger patients with longer life-expectancy. Herein, we highlight the incidence, predictors, impact and management of CA in patients undergoing TAVI. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
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15 pages, 638 KiB  
Review
Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation
J. Cardiovasc. Dev. Dis. 2023, 10(7), 265; https://doi.org/10.3390/jcdd10070265 - 21 Jun 2023
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Abstract
Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, [...] Read more.
Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, frailty, and patient preference. While both options offer significant benefits to patients in terms of clinical outcomes and quality of life, there is growing interest in expanding the indications for TAVI due to its minimally invasive approach. However, it is worth noting that there are several discrepancies in TAVI outcomes in regards to various endpoints, including death, stroke, and major cardiovascular events. It is unclear why these discrepancies exist, but potential explanations include the diversity of etiologies for aortic stenosis, complex patient comorbidities, and ongoing advancements in both medical therapies and devices. Of these possibilities, we propose that phenotypic variation of aortic stenosis has the most significant impact on post-TAVI clinical outcomes. Such variability in phenotypes is often due to a complex interplay between underlying comorbidities and environmental and inherent patient risk factors. However, there is growing evidence to suggest that patient genetics may also play a role in aortic stenosis pathology. As such, we propose that the selection and management of TAVI patients should emphasize a precision medicine approach. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)
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