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Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects
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Transcatheter Aortic Valve Implantation: Recent Advances and Future 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 (30 December 2024) | Viewed by 5528

Special Issue Editors

Dr. Andreas S. Kalogeropoulos

E-Mail Website
Guest Editor
Department of Cardiology, Mitera General Hospital, 151 23 Athens, Greece
Interests: complex PCI; mchronic total occlusion percutaneous revascularization; intravascular imaging; transcatheter aortic valve implantation
Dr. Tiffany Patterson

E-Mail Website
Guest Editor
St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
Interests: structural heart interventions; transcatheter aortic valve implantation; transcatheter edge-to-edge repair of mitral valve; percutaneous coronary artery interventions

Special Issue Information

Dear Colleagues,

Transcatheter aortic valve implantation (TAVI) has utterly reformed the management of symptomatic severe aortic stenosis. As new technologies have been introduced and techniques of implantation have been revolutionized, TAVI has now become the leading therapeutic strategy for aortic valve replacement in most patients with severe symptomatic AS. The more contemporary minimalistic approach using conscious sedation or even just local anesthesia, the adaptation of techniques to improve commissural alignment and facilitate coronary access after implantation, the innovation regarding the TAVI bioprosthesis with technologies to further improve valve durability along with accumulating experience have resulted in a substantial reduction in procedural complications and improvement of post-TAVI short- and long-term outcomes.

We are pleased to invite you to submit articles regarding the forthcoming Special Issue entitled “Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects”.

In this Special Issue, we are aiming to provide a review on the current status and the fundamental aspects regarding the TAVI procedure. The topic editors encourage the submission of articles highlighting the latest advances in the field, and present interesting data with regards to the role of revascularization and commissural alignment in patients undergoing TAVI and direct comparison of different TAVI bioprostheses (balloon-expandable vs. self-expandable) in several areas including need for pacemaker post-TAVI , haemodynamic performance and paravalvular leaks. In addition, this Special issue will aim to include opinions regarding several future perspectives such as the lifetime management of younger patients with severe AS, the role of TAVI in patients with bicuspid aortic valves and aortic stenosis, pure aortic regurgitation, and those with asymptomatic aortic stenosis.

In this Special Issue, original articles and reviews are welcome. Research areas may include but are not limited to the following:

  1. Outcomes post-TAVI;
  2. Comparison of different bioprostheses regarding haemodynamic performance post-TAVI, rates of PPM implantation and paravalvular leaks;
  3. The role of revascularization in patients undergoing TAVI;
  4. Lifelong management of patients with severe aortic stenosis;
  5. TAVI and minimalistic approach;
  6. Comparison of different access routes during TAVI.

Dr. Andreas S. Kalogeropoulos
Dr. Tiffany Patterson
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

  • TAVI
  • TAVR
  • aortic stenosis
  • bioprosthesis
  • paravalvular leak
  • CT TAVI
  • transfemoral
  • TAVI access
  • PPM post-TAVI
  • commissural alignment

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Published Papers (4 papers)

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Research

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21 pages, 8277 KiB  
Article
Finite Element Analysis of Evolut Transcatheter Heart Valves: Effects of Aortic Geometries and Valve Sizes on Post-TAVI Wall Stresses and Deformations
by Onur Mutlu, Noaman Mazhar, Murat Saribay, Mehmet Metin Yavuz, Deniz Ozturk, Abdel Naser Ghareeb, Abdulrahman Alnabti and Huseyin Cagatay Yalcin
J. Clin. Med. 2025, 14(3), 850; https://doi.org/10.3390/jcm14030850 - 27 Jan 2025
Viewed by 871
Abstract
Background/Objectives: For transcatheter aortic valve implantation (TAVI) therapy, a catheter-guided crimped valve is deployed into the aortic root. Valve types such as Edwards balloon-expandable valves and Medtronic self-expandable valves come in different sizes and are chosen based on patient-specific aortic anatomy, including aortic [...] Read more.
Background/Objectives: For transcatheter aortic valve implantation (TAVI) therapy, a catheter-guided crimped valve is deployed into the aortic root. Valve types such as Edwards balloon-expandable valves and Medtronic self-expandable valves come in different sizes and are chosen based on patient-specific aortic anatomy, including aortic root diameter measurement. Complications may arise due to variations in anatomical characteristics and the implantation procedure, making pre-implantation assessment important for predicting complications. Methods: Computational modeling, particularly finite element analysis (FEA), has become popular for assessing wall stresses and deformations in TAVI. In this study, a finite element model including the aorta, native leaflets, and TAVI device was used to simulate procedures and assess patient-specific wall stresses and deformations. Results: Using the Medtronic Evolut R valve, we simulated TAVI for 14 patients to analyze the effects of geometrical variations on structural stresses. Virtual TAVIs with different valve sizes were also simulated to study the influence of TAV size on stresses. Our results show that variations in aortic wall geometries and TAV sizes significantly influence wall stresses and deformations. Conclusions: Our study is one of the first comprehensive FEA investigations of aortic geometrical variations and valve sizes on post-TAVI stresses, demonstrating the non-linear relationship between aortic dimensions, TAV sizes, and wall stresses. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects)
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12 pages, 973 KiB  
Article
Contrast Volume-to-Estimated Glomerular Filtration Rate Ratio as a Predictor of Short-Term Outcomes Following Transcatheter Aortic Valve Implantation
by Omar Chehab, Giulia Esposito, Edouard J. B. Long, Clarissa Ng Yin Ling, Samuel Hale, Samuel Malomo, Nanci O’Reilly, Anthony Mathur, Andreas Baumbach, Mick Ozkor, Simon Kennon and Michael Mullen
J. Clin. Med. 2024, 13(10), 2971; https://doi.org/10.3390/jcm13102971 - 17 May 2024
Viewed by 1557
Abstract
Background/Objectives: Contrast-induced acute kidney injury (AKI) is associated with early mortality and adverse events. However, in the setting of transcatheter aortic valve implantation (TAVI), previous literature has failed to establish a correlation between the absolute volume of contrast media administered and mortality. We [...] Read more.
Background/Objectives: Contrast-induced acute kidney injury (AKI) is associated with early mortality and adverse events. However, in the setting of transcatheter aortic valve implantation (TAVI), previous literature has failed to establish a correlation between the absolute volume of contrast media administered and mortality. We aimed to investigate the impact of contrast volume administered normalised to estimated glomerular filtration rate (CV/eGFR) on the development of AKI and on 30-day all-cause mortality in TAVI patients. Methods: We retrospectively analysed a cohort of 1150 patients who underwent TAVI at our unit between 2015 and 2018. Results: Follow-up was complete for 1064 patients. There were 23 deaths within the follow-up period and 76 cases of AKI, 9 of which required new renal replacement therapy (RRT). Receiver-operating characteristic (ROC) curve analysis showed fair discrimination for 30-day all-cause mortality at a CV/eGFR ratio of 3.6 (area under the ROC curve (AUC) 0.671). Of patients in whom CV data were available, 86.0% (n = 757) had a CV/eGFR < 3.6 and 14.0% (n = 123) had a CV/eGFR ≥ 3.6. In multivariate logistic regression analysis, CV/eGFR ≥ 3.6 was the strongest predictor of 30-day all-cause mortality (odds ratio 5.06, 95% confidence interval [1.61–15.7], p = 0.004). Other independent predictors were procedural urgency (3.28 [1.04–10.3], p = 0.038) and being under general anaesthesia (4.81 [1.10–17.3], p = 0.023). CV/eGFR ≥ 3.6 was also independently associated with significantly increased odds of AKI (2.28 [1.20–4.17], p = 0.009) alongside significant non-left main stem coronary artery disease (2.56 [1.45–4.66], p = 0.001), and diabetes (1.82 [1.03–3.19], p = 0.037). In supplementary ROC curve analysis, a similar CV/eGFR cut point of 3.6 was found to be an excellent predictor for new RRT (AUC 0.833). Conclusions: In conclusion, a CV/eGFR ≥ 3.6 post-TAVI was found to be a strong predictor of 30-day mortality and AKI. The maximum contrast volume that can be safely administered in each patient without significantly increasing the risk of mortality and AKI can be calculated using this ratio. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects)
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14 pages, 1557 KiB  
Article
Clinical Implication of Supra-Normal Left Ventricular Ejection Fraction in Patients Undergoing Transcatheter Aortic Valve Replacement
by Teruhiko Imamura, Yuki Hida, Hiroshi Ueno, Koichiro Kinugawa, Fumiaki Yashima, Norio Tada, Masahiro Yamawaki, Shinichi Shirai, Toru Naganuma, Futoshi Yamanaka, Masahiko Noguchi, Kazuki Mizutani, Kensuke Takagi, Yusuke Watanabe, Masanori Yamamoto, Masahiko Asami, Masaki Izumo, Yohei Ohno, Hidetaka Nishida, Kentaro Hayashida and on behalf of the OCEAN-TAVI Investigatorsadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(23), 7429; https://doi.org/10.3390/jcm12237429 - 30 Nov 2023
Cited by 4 | Viewed by 1515
Abstract
Background: Individuals with heart failure displaying supra-normal left ventricular ejection fraction (snLVEF) may exhibit less favorable clinical outcomes in contrast to their counterparts with normal left ventricular ejection fraction (nLVEF). The distinctive characteristics and mid-term prognosis of individuals with severe aortic stenosis and [...] Read more.
Background: Individuals with heart failure displaying supra-normal left ventricular ejection fraction (snLVEF) may exhibit less favorable clinical outcomes in contrast to their counterparts with normal left ventricular ejection fraction (nLVEF). The distinctive characteristics and mid-term prognosis of individuals with severe aortic stenosis and snLVEF following transcatheter aortic valve replacement (TAVR) remain enigmatic. Methods: Among 7393 patients diagnosed with severe aortic stenosis who underwent TAVR between 2013 and 2019 and were enlisted in the optimized transcatheter valvular intervention (OCEAN-TAVI) multicenter registry (UMIN000020423), we selected patients with left ventricular ejection fraction (LVEF) ≥ 50%. snLVEF was defined as LVEF exceeding 65%. We compared the baseline characteristics and assessed three-year post-TAVR mortality and heart failure readmission rates between the snLVEF (LVEF > 65%) and nLVEF cohorts (LVER 50–65%). Results: Our study cohort comprised 5989 patients (mean age 84.4 ± 5.1 years and 1783 males). Among these, 2819 patients were categorized within the snLVEF cohort, while the remaining 3170 were allocated to the nLVEF group. Individuals within the snLVEF cohort were more likely to be female and displayed lower levels of natriuretic peptides, as well as smaller left ventricular dimensions in comparison to their nLVEF counterparts (p < 0.05 for all). The presence of snLVEF emerged as an independent predictor of the three-year composite endpoint relative to nLVEF, with an adjusted hazard ratio of 1.16 (95% confidence interval 1.02–1.31, p = 0.023) after accounting for several potential confounding factors. Conclusions: snLVEF was relatively common among candidates for TAVR with preserved ejection fraction. Patients harboring snLVEF appear to manifest a distinctive clinical profile and encounter less favorable clinical outcomes following TAVR in contrast to those characterized by nLVEF. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects)
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Review

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17 pages, 2626 KiB  
Review
Transcatheter Aortic Valve Implantation (TAVI) in Bicuspid Anatomy
by Dimitrios N. Nikas, Lampros Lakkas, Katerina K. Naka and Lampros K. Michalis
J. Clin. Med. 2025, 14(3), 772; https://doi.org/10.3390/jcm14030772 - 24 Jan 2025
Viewed by 891
Abstract
Bicuspid aortic valve (BAV) stenosis, a common congenital condition, presents unique challenges for transcatheter aortic valve replacement (TAVI) due to anatomical variations like cusp morphology, coexisting aortopathy and calcification. TAVI offers a viable option for BAV patients with refinements in technique and technology, [...] Read more.
Bicuspid aortic valve (BAV) stenosis, a common congenital condition, presents unique challenges for transcatheter aortic valve replacement (TAVI) due to anatomical variations like cusp morphology, coexisting aortopathy and calcification. TAVI offers a viable option for BAV patients with refinements in technique and technology, though ongoing research is essential to optimize patient-specific approaches and long-term results. Key considerations for TAVI in BAV include precise valve sizing, positioning, and the need for rigorous pre-procedural imaging to mitigate risks such as paravalvular leak and stroke. Early results show TAVI’s safety and efficacy are comparable to surgery, though BAV patients undergoing TAVI often are exposed to higher rates of post-procedural pacemaker implantation. Emerging data on next-generation self-expandable (SE) and balloon-expandable (BE) valves reveal that while both offer success in this complex anatomical aortic valve variation, gaps remain in the long-term durability and management of BAV-related aortopathy. This review examines the latest advancements in TAVI for BAV, emphasizing how specialized approaches and device selection address BAV’s complexities. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Prospects)
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