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Transcatheter Aortic Valve Replacement: Latest Advances and Prospects
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Transcatheter Aortic Valve Replacement: Latest Advances and Prospects

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

Deadline for manuscript submissions: closed (20 August 2023) | Viewed by 7931

Special Issue Editors

Dr. Lluís Asmarats

E-Mail
Guest Editor
Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Interests: structural heart disease; transcatheter aortic valve replacement; transcatheter mitral valve repair; transcatheter tricuspid valve repair; left atrial appendage occlusion
Dr. Dabit Arzamendi

E-Mail Website
Guest Editor
Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Interests: structural heart disease; transcatheter aortic valve replacement; transcatheter mitral valve repair; transcatheter tricuspid valve repair; left atrial appendage occlusion

Special Issue Information

Dear Colleagues,

Aortic stenosis is the most common degenerative valvular heart disease leading to surgery or transcatheter therapy in Europe and North America. During the last decade, transcatheter aortic valve replacement (TAVR) has become an established treatment for elderly patients with severe aortic stenosis across the surgical risk spectrum and is currently recommended in younger patients with an age threshold of 65 years and 75 years in the US and Europe, respectively. Despite the substantial reduction in procedural complications with device iterations, increasing experience and procedure simplification, when they do occur, they may have a negative impact on patient outcomes. Therefore, continuous efforts seek to minimize some of the knowledge gaps and unresolved issues, such as choice of intervention in patients with bicuspid aortic valve or small aortic annulus, management of concomitant comorbidities (coronary artery disease, anemia, valve disease), conduction disturbances, future coronary access, feasibility of TAVI-in-TAVI, and long-term durability.

This Special Issue aims to address some of these gaps, including pre-procedural planning, streamline procedure, and post-procedural management, to improve clinical outcomes and ensure the best lifetime management for these patients. Both original research contributions and state-of-the-art reviews are welcome.

Dr. Lluís Asmarats
Dr. Dabit Arzamendi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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
  • pacemaker
  • stroke
  • bleeding
  • bicuspid aortic valve

Published Papers (5 papers)

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Research

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10 pages, 711 KiB  
Article
Risk Stratification for Pacemaker Implantation after Transcatheter Aortic Valve Implantation in Patients with Right Bundle Branch Block
by Simon Schoechlin, Martin Eichenlaub, Björn Müller-Edenborn, Franz-Josef Neumann, Thomas Arentz, Dirk Westermann and Amir Jadidi
J. Clin. Med. 2022, 11(19), 5580; https://doi.org/10.3390/jcm11195580 - 22 Sep 2022
Cited by 2 | Viewed by 1213
Abstract
Background: Permanent pacemaker implantation (PPI) after transcatheter valve implantation (TAVI) is a common complication. Pre-existing right bundle branch block (RBBB) is a strong risk factor for PPI after TAVI. However, a patient-specific approach for risk stratification in this subgroup has not yet been [...] Read more.
Background: Permanent pacemaker implantation (PPI) after transcatheter valve implantation (TAVI) is a common complication. Pre-existing right bundle branch block (RBBB) is a strong risk factor for PPI after TAVI. However, a patient-specific approach for risk stratification in this subgroup has not yet been established. Methods: We investigated TAVI patients with pre-existing RBBB to stratify risk factors for PPI and 1-year-mortality by detailed analysis of ECG data, RBBB morphology and degree of calcification in the implantation area assessed by computed tomography angiography. Results: Between 2010 and 2018, 2129 patients underwent TAVI at our institution. Among these, 98 pacemaker-naïve patients with pre-existing RBBB underwent a TAVI procedure. PPI, because of relevant conduction disturbances (CD), was necessary in 43 (43.9%) patients. PPI was more frequently indicated in women vs. men (62.1% vs. 32.8%, p = 0.004) and in men treated with a self-expandable vs. a balloon-expandable valve (58.3% vs. 26.5%, p = 0.035). ECG data (heart rhythm, PQ, QRS, QT) and RBBB morphology had no influence on PPI rate, whereas risk for PPI increased with the degree of calcification in the left septal His-/left bundle branch-area to a 9.375-fold odds for the 3rd tertile of calcification (1.639–53.621; p = 0.012). Overall, 1-year-mortality was comparable among patients with or without PPI (14.0% vs. 16.4%; p = 0.697). Conclusions: Patients with RBBB undergoing TAVI have a high risk of PPI. Among this subgroup, female patients, male patients treated with self-expandable valve types, patients with high load/degree of non-coronary LVOT calcification and patients with atrial fibrillation need enhanced surveillance for CD after procedure. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Latest Advances and Prospects)
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Review

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13 pages, 11139 KiB  
Review
The Incidence, Impact, and Techniques of Commissural Alignment in Transcatheter Aortic Valve Implantation: A Review
by Jose G. Paredes-Vazquez, Gabriela Tirado-Conte, Asad Shabbir, Matias Mon-Noboa, Jorge F. Chavez, Ivan Nuñez-Gil, Pilar Jimenez-Quevedo, Eduardo Pozo-Osinalde, Jose Juan Gomez de Diego, Pablo Salinas, Hernan Mejia-Renteria, Fernando Macaya, Jose Alberto de Agustin-Loeches, Nieves Gonzalo, Javier Escaned, Antonio Fernandez-Ortiz and Luis Nombela-Franco
J. Clin. Med. 2023, 12(23), 7369; https://doi.org/10.3390/jcm12237369 - 28 Nov 2023
Viewed by 1077
Abstract
In current clinical practice, commissural alignment of the transcatheter heart valve (THV) during transcatheter aortic valve implantation (TAVI) is seldom achieved. Orientation of the THV within the aortic root and the subsequent influence upon leaflet haemodynamic function, coronary blood flow, and ease of [...] Read more.
In current clinical practice, commissural alignment of the transcatheter heart valve (THV) during transcatheter aortic valve implantation (TAVI) is seldom achieved. Orientation of the THV within the aortic root and the subsequent influence upon leaflet haemodynamic function, coronary blood flow, and ease of access to the coronary ostia are gaining significant interest. Herein, we review the incidence and clinical implications of commissural misalignment in TAVI and offer thorough descriptions of how optimal alignment can be achieved with several different contemporary THV devices. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Latest Advances and Prospects)
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11 pages, 2997 KiB  
Review
Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valve Disease: Procedural Planning and Clinical Outcomes
by Lola Gutierrez, Mauro Boiago, Chiara De Biase, Omar Oliva, Pietro Laforgia, Souheib Feliachi, Alessandro Beneduce, Nicolas Dumonteil and Didier Tchetche
J. Clin. Med. 2023, 12(22), 7074; https://doi.org/10.3390/jcm12227074 - 14 Nov 2023
Viewed by 1159
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 1–2% and occurring in >20% of octogenarians referred for aortic valve replacement. However, BAV patients have been systematically excluded from pivotal randomized trials. Since TAVI indications are moving [...] Read more.
Bicuspid aortic valve (BAV) is the most common congenital heart disease, with a prevalence of 1–2% and occurring in >20% of octogenarians referred for aortic valve replacement. However, BAV patients have been systematically excluded from pivotal randomized trials. Since TAVI indications are moving toward low-risk patients, an increase in the number of BAV patients who undergo TAVI is expected. BAV represents a challenge due to its unique morphological features (raphe, extreme asymmetrical valve calcifications, cusp asymmetry and aortopathy) and the lack of consensus about the accurate sizing method. The role of multi-slice computed tomography (MSCT) in the planification of the TAVI procedure is well-established, being useful to define the optimal valve sizing and the implantation strategy. New-generation devices, more experience of the operators and better planification of the procedure have been associated with similar clinical outcomes in bicuspid and tricuspid patients undergoing TAVI. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Latest Advances and Prospects)
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14 pages, 2459 KiB  
Review
Redo-TAVR: Essential Concepts, Updated Data and Current Gaps in Evidence
by Attílio Galhardo, Marisa Avvedimento, Siddhartha Mengi and Josep Rodés-Cabau
J. Clin. Med. 2023, 12(14), 4788; https://doi.org/10.3390/jcm12144788 - 20 Jul 2023
Viewed by 1525
Abstract
Within the last two decades, transcatheter aortic valve replacement (TAVR) has transformed the treatment strategy for symptomatic severe aortic stenosis (AS), representing a less invasive alternative to traditional open-chest surgery. With time, advances in device features, imaging planning, and implantation techniques have contributed [...] Read more.
Within the last two decades, transcatheter aortic valve replacement (TAVR) has transformed the treatment strategy for symptomatic severe aortic stenosis (AS), representing a less invasive alternative to traditional open-chest surgery. With time, advances in device features, imaging planning, and implantation techniques have contributed to an improvement in safety as well as a reduction in procedural complications. This has led to the expansion of TAVR to lower-risk patients, where TAVR has shown favorable outcomes compared to surgical aortic valve replacement (SAVR). As TAVR expands to younger and lower-risk patients with longer life expectancies, the need for reintervention for failing transcatheter heart valves is expected to increase. Redo-TAVR has gained increasing relevance in the lifetime management of AS as one of the treatment strategies available for structural valve dysfunction (SVD). However, some issues are associated with this approach, including coronary re-access and the risk of coronary obstruction. In this review, we provide essential concepts to properly select candidates for Redo-TAVR, updated data on clinical outcomes and complication rates, and current gaps in evidence. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Latest Advances and Prospects)
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Other

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14 pages, 1966 KiB  
Systematic Review
The Efficacy and Safety of Direct Oral Anticoagulants versus Standard of Care in Patients without an Indication of Anti-Coagulants after Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials
by Mohamed Abuelazm, Basel Abdelazeem, Basant E. Katamesh, Mohamed Gamal, Lakshmi Venkata Simhachalam Kutikuppala, Babikir Kheiri, James Robert Brašić and Timir K. Paul
J. Clin. Med. 2022, 11(22), 6781; https://doi.org/10.3390/jcm11226781 - 16 Nov 2022
Viewed by 2295
Abstract
Transcatheter aortic valve replacement (TAVR) is now considered the mainstay of aortic stenosis management; however, the optimal antithrombotic therapy in patent without indications for an oral anticoagulant (OAC) is yet to be identified. Therefore, we conducted a systematic review and meta-analysis to evaluate [...] Read more.
Transcatheter aortic valve replacement (TAVR) is now considered the mainstay of aortic stenosis management; however, the optimal antithrombotic therapy in patent without indications for an oral anticoagulant (OAC) is yet to be identified. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of direct oral anticoagulant (DOAC) treatment versus the standard of care in patients without indications of OACs after TAVR. We synthesized randomized controlled trials (RCTs) from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 18 August 2022. We used the risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022357027. Three RCTs with 2922 patients were identified. DOACs were significantly associated with higher incidence of all-cause mortality (RR: 1.68 with 95% CI [1.22, 2.30], p = 0.001), mortality due to non-cardiovascular causes (RR: 2.34 with 95% CI [1.36, 4.02], p = 0.002), and the composite outcome of death, myocardial infarction, or stroke (RR: 1.41 with 95% CI [1.13, 1.76], p = 0.002). However, DOACs were associated with decreased incidence of reduced leaflet motion (RLM) (RR: 0.19 with 95% CI [0.09, 0.41], p = 0.0001) and hypoattenuated leaflet thickening (HALT) (RR: 0.50 with 95% CI [0.36, 0.70], p = 0.0001). DOACs were effective to reduce RLM and HALT; however, the clinical effect of this is still controversial. DOACs were associated with worse efficacy and safety outcomes, including all-cause mortality. Further RCTs investigating the optimal antithrombotic regimen after TAVR. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Latest Advances and Prospects)
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