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Transcatheter Aortic Valve Implantation (TAVI) II

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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: closed (31 December 2024) | Viewed by 15918

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Prof. Dr. Enrico Ferrari

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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
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Dr. Sergio Berti

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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

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Keywords

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

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Published Papers (9 papers)

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Research

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15 pages, 680 KiB

Open AccessArticle

One-Year Outcome of Patients Undergoing Transcatheter Aortic Valve Replacement with Concomitant SignificantTricuspid Regurgitation

by Enrico Ferrari, Alberto Pozzoli, Catherine Klersy, Elena Caporali, Stefanos Demertzis and Giovanni Pedrazzini

J. Cardiovasc. Dev. Dis. 2025, 12(5), 184; https://doi.org/10.3390/jcdd12050184 - 14 May 2025

Viewed by 179

Abstract

Background: The outcome of patients undergoing transcatheter aortic valve replacement (TAVR) can be affected by coexisting tricuspid regurgitation (TR). The aim of the study is to investigate the clinical results of patients undergoing TAVR with or without concomitant significant TR. Methods: Patients undergoing TAVR were divided into two groups according to TR severity: none/mild TR (low-grade) and moderate/severe TR (significant). Data were analysed and compared. Primary endpoint was the mortality 1-year. Secondary endpoints were re-hospitalization and the degree of postoperative and 1-year TR. Results: TAVR procedures were performed in 345 patients between September 2011 and February 2020. Median STS score was 4.3% (IQR: 2.6–7.2), median LVEF was 59.0% (IQR: 45.0–62.0), median aortic area was 0.70cm² (IQR: 0.60–0.86), median mean gradient was 43.0mmHg (IQR: 36.0–53.0). Before TAVR, 297 patients (86.1%) had low-grade TR and 48 (13.9%) significant TR. Mean age was 82.4 ± 5.7 and 83.8 ± 6.2 years in low-grade and significant TR group, respectively (p = 0.109), with 47.5% (low-grade TR) and 56.3% (significant TR) of female patients (p = 0.279). Patients showed differences in EuroSCORE-II (3.2% (IQR: 1.9–5.7) in low-grade TR vs. 5.6% (IQR: 3.7–8.1) in significant TR; p < 0.001), impaired right ventricular function (3.0% vs. 20.8%; p < 0.001) and pulmonary hypertension (9.1% vs. 39.6%; p < 0.001). Mean valve size was 27.7 ± 2.9 mm. Hospital mortality was 2.0% in low-grade TR and 4.2% in significantTR patients (p = 0.308). Among discharged patients (n = 337), seven patients died within 30 days (2.0% low-grade TR; 2.1% significant TR; logrank test p = 0.154) and 40 were re-hospitalized for heart failure (11.1% low-grade TR; 14.6% significant TR; p = 0.470). After one year, 26 patients died, corresponding to a mortality of 7.9 deaths per 100-person year (95% CI 5.2–12.0) in low-grade TR group and 9.1 deaths per 100-person year (95% CI 3.4–24.3) in significant TR group (logrank test p = 0.815), with HR (low grade vs. significant TR) of 0.87, 95% CI 0.26–2.89. Re-hospitalization for heart failure was 16.5% and 19.6% for low-grade and significant TR, respectively (p = 0.713). Echocardiographic and functional changes over time showed no significant interaction between TR and time. Conclusions: In our experience, patients undergoing TAVR showed similar 30-day and 1-year outcome and re-hospitalization rate, regardless of the degree of concomitant tricuspid regurgitation. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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14 pages, 2218 KiB

Open AccessArticle

Rapid Improvement in Cardiac Damage Predicts Better Prognosis After Transcatheter Aortic Valve Replacement

by Hao-Wei Lee, Chih-Hui Chin, Po-chin Chou, Chia-Hsiu Chang, Chiu-Ling Tsai and Chi-Hung Huang

J. Cardiovasc. Dev. Dis. 2025, 12(1), 29; https://doi.org/10.3390/jcdd12010029 - 16 Jan 2025

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Abstract

Background: A staging system based on cardiac damage for severe aortic stenosis (AS) has been validated for prognosis prediction following transcatheter aortic valve replacement (TAVR). Our study aims to investigate whether TAVR can lead to changes in cardiac damage shortly after the procedure and how these changes impact prognosis. Method: Patients in this retrospective cohort study were classified into five stages (0–4) before TAVR based on the echocardiographic findings of cardiac damage. The closest echocardiogram after TAVR was used for restaging cardiac damage. The primary composite outcome was all-cause mortality or hospitalization due to heart failure (HF). Results: A total of 64 patients were enrolled (53.1% male, mean age 81.7 ± 7.7 years). Within a mean interval of 4 days (interquartile range = 3 to 7 days) after TAVR, cardiac damage improved in 25.0% of patients, while it worsened in 20.3%. During a median follow-up of 2.5 ± 1.9 years, 34.4% of patients met the primary endpoint, which included 16 deaths and 6 HF hospitalizations. Cox regression analysis revealed that improvement in cardiac damage correlated with a lower risk of composite death or HF hospitalization (HR: 0.095; 95% CI: 0.014–0.627; p = 0.015). Conclusions: TAVR can lead to changes in cardiac damage over a short period in patients with severe AS, and rapid improvement in cardiac damage after TAVR is associated with a better prognosis. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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13 pages, 1094 KiB

Open AccessArticle

Ten-Year Experience with a Transapical Approach for Transcatheter Aortic and Mitral Valve Implantation

by Antonella Galeone, Fabiola Perrone, Gabriele Pesarini, Flavio Luciano Ribichini, Renato Di Gaetano, Giovanni Battista Luciani and Francesco Onorati

J. Cardiovasc. Dev. Dis. 2024, 11(7), 201; https://doi.org/10.3390/jcdd11070201 - 29 Jun 2024

Cited by 1 | Viewed by 1120

Abstract

Background: The transfemoral approach represents the optimal access for TAVI due to its low invasiveness; however, up to 10–15% of TAVI candidates are considered unsuitable for femoral access because of significant peripheral vascular disease and need alternative access. Methods: This is a single-center retrospective observational study including all consecutive adult patients undergoing transcatheter procedures through a TA approach from March 2015 to April 2024. Results: 213 patients underwent transcatheter aortic or mitral valve implantation through a TA approach and were enrolled in this study. The mean age of the patients was 79.5 ± 5.7 years, and 54% of the patients were males. The mean Euroscore II was 7.9 ± 6.4%. One-third of the patients had previous cardiac surgery. The overall mean survival time was 5.3 ± 0.3 years. Nine (4%) patients developed infective endocarditis (IE) during the follow-up. Conclusions: The transapical approach for transcatheter procedures is a safe and effective procedure for patients unsuitable for TF access with low periprocedural mortality and a low rate of post-procedural complications when performed by experienced surgeons and cardiologists. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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15 pages, 1594 KiB

Open AccessArticle

Association between Neuron-Specific Enolase, Memory Function, and Postoperative Delirium after Transfemoral Aortic Valve Replacement

by Jonathan Nübel, Charlotte Buhre, Meike Hoffmeister, Stefanie Oess, Oliver Labrenz, Kerstin Jost, Michael Hauptmann, Julika Schön, Georg Fritz, Christian Butter and Anja Haase-Fielitz

J. Cardiovasc. Dev. Dis. 2023, 10(11), 441; https://doi.org/10.3390/jcdd10110441 - 25 Oct 2023

Cited by 4 | Viewed by 2351

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 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

Open AccessArticle

The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement

by Annamaria Mazzone, Serena Del Turco, Giuseppe Trianni, Paola Quadrelli, Marco Marotta, Luca Bastiani, Tommaso Gasbarri, Andreina D’Agostino, Massimiliano Mariani, Giuseppina Basta, Ilenia Foffa, Silverio Sbrana, Cristina Vassalle, Marcello Ravani, Marco Solinas and Sergio Berti

J. Cardiovasc. Dev. Dis. 2023, 10(5), 212; https://doi.org/10.3390/jcdd10050212 - 13 May 2023

Cited by 3 | Viewed by 2025

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 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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22 pages, 401 KiB

Open AccessReview

Obesity and Transcatheter Aortic Valve Replacement

by Jiyoung Seo, Amrin Kharawala, Pawel Borkowski, Nikita Singh, Harriet Akunor, Sanjana Nagraj, Dimitrios V. Avgerinos and Damianos G. Kokkinidis

J. Cardiovasc. Dev. Dis. 2024, 11(6), 169; https://doi.org/10.3390/jcdd11060169 - 30 May 2024

Cited by 2 | Viewed by 1452

Abstract

Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called “obesity paradox”—a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts—merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity’s role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

10 pages, 738 KiB

Open AccessReview

Transcatheter Aortic Valve Implantation and Conduction Disturbances: Focus on Clinical Implications

by Antonios Halapas, Leonidas Koliastasis, Ioannis Doundoulakis, Christos-Konstantinos Antoniou, Christodoulos Stefanadis and Dimitrios Tsiachris

J. Cardiovasc. Dev. Dis. 2023, 10(11), 469; https://doi.org/10.3390/jcdd10110469 - 19 Nov 2023

Cited by 4 | Viewed by 2579

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 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

Open AccessReview

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

by Muzamil Khawaja, Hafeez Ul Hassan Virk, Dhrubajyoti Bandyopadhyay, Mario Rodriguez, Johao Escobar, Mahboob Alam, Hani Jneid and Chayakrit Krittanawong

J. Cardiovasc. Dev. Dis. 2023, 10(7), 265; https://doi.org/10.3390/jcdd10070265 - 21 Jun 2023

Viewed by 2656

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, 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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Open AccessEditor’s ChoiceSystematic Review

The Impact of Frailty and Surgical Risk on Health-Related Quality of Life After TAVI

by Kim E. H. M. van der Velden, Bart P. A. Spaetgens, Wolfgang F. F. A. Buhre, Bart Maesen, Dianne J. D. de Korte-de Boer, Sander M. J. van Kuijk, Arnoud W. J. van ‘t Hof and Jan U. Schreiber

J. Cardiovasc. Dev. Dis. 2024, 11(10), 333; https://doi.org/10.3390/jcdd11100333 - 18 Oct 2024

Cited by 1 | Viewed by 1484

Abstract

Symptomatic aortic stenosis and frailty reduce health-related quality of life (HrQoL). Transcatheter aortic valve implantation (TAVI) in patients at high to extreme risk has been proven to have a beneficial effect on HrQoL. Currently, TAVI is also considered in patients at intermediate risk. Our meta-analysis investigates whether benefits to HrQoL after TAVI is more pronounced in frail patients and patients at high to extreme vs. intermediate surgical risk. A systematic search of the literature was performed in November 2021 and updated in November 2023 in PUBMED, EMBASE, and the Cochrane Controlled Trials Register. Statistical analysis was performed according to the inverse variance method and the random effects model. A total of 951 studies were assessed, of which 19 studies were included. Meta-analysis showed a mean increase in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 29.6 points (6.0, 33.1) in high to extreme risk patients versus 21.0 (20.9, 21.1) in intermediate risk patients (p < 0.00001) and 24.6 points (21.5, 27.8) in frail patients versus 26.8 (20.2, 33.4) in the general TAVI population (p = 0.55). However, qualitative analyses of non-randomized studies showed the opposite results. In conclusion, TAVI improves HrQoL more in high to extreme than intermediate risk patients. Frailty’s impact on HrQoL post-TAVI is inconclusive due to varying outcomes in RCTs vs. non-RCTs. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation (TAVI) II)

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