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Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges
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Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges

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 July 2025) | Viewed by 6983

Special Issue Editors

Prof. Dr. Konstantinos Toutouzas

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Guest Editor
Unit of Structural Heart Diseases, First Department of Cardiology, Athens Medical School, 11527 Athens, Greece
Interests: structural heart disease; mitral and aortic valvuloplasty; transcatheter aortic valve implantations; intravascular imaging; percutaneous coronary interventions
Special Issues, Collections and Topics in MDPI journals
Dr. Panayotis Vlachakis

E-Mail
Guest Editor Assistant
Unit of Structural Heart Diseases, First Department of Cardiology, Athens Medical School, 11527 Athens, Greece
Interests: structural heart disease; valvulopathies; transcatheter aortic valve implantations; coronary artery disease; percutaneous coronary interventions; antiplatelet treatment
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

During the last decade, scientific validation of Transcatheter Aortic Valve Implantation (TAVI) has considerably changed the management of patients with symptomatic aortic stenosis. The introduction of new technologies and the evolution of TAVI devices have already expanded current indications and refined clinical outcomes.

This Special Issue aims to address emerging challenges and knowledge gaps in the field of TAVI, focusing on expanding clinical indications, optimizing outcomes, and advancing Valve-in-Valve and TAVI-in-TAVI techniques.

We are particularly interested in studies that explore TAVI in special populations, investigate long-term durability and patient–prosthesis mismatch, and examine outcomes and decision-making for Valve-in-Valve and complex repeat-TAVI procedures.

We welcome the submission of original research, review articles, and real-world data that deepen our understanding of TAVI applications and outcomes. Topics of interest for this Special Issue include patient selection, procedural innovations, technical challenges, and long-term durability.

Prof. Dr. Konstantinos Toutouzas
Guest Editor

Dr. Panayotis Vlachakis
Guest Editor Assistant

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
  • aortic stenosis
  • valve-in-valve
  • structural heart disease
  • TAVI-in-TAVI

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Related Special Issue

Published Papers (5 papers)

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Research

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16 pages, 366 KB  
Article
Sex-Based Differences in Hemodynamic Response to Anesthesia Type During TAVI and Early Transvalvular Gradient Changes
by Benjamin Fogelson, Raj Baljepally, Phoebe Tran, Eric Heidel, Terrance C. Nowell, Billy Morvant, Steve Ferlita, Stefan Weston, Aladen Amro, Kirsten Ferraro, Zachary Spires and Soham Nadkarni
J. Clin. Med. 2025, 14(19), 6693; https://doi.org/10.3390/jcm14196693 - 23 Sep 2025
Viewed by 220
Abstract
Background and Objectives: Anesthesia type may influence early hemodynamics post-transcatheter aortic valve implantation (TAVI), but sex-based differences in anesthetic response remain underexamined. We aimed to assess whether male and female patients exhibit differential responses to general anesthesia (GA) versus monitored anesthesia care (MAC) [...] Read more.
Background and Objectives: Anesthesia type may influence early hemodynamics post-transcatheter aortic valve implantation (TAVI), but sex-based differences in anesthetic response remain underexamined. We aimed to assess whether male and female patients exhibit differential responses to general anesthesia (GA) versus monitored anesthesia care (MAC) during TAVI, with particular attention to post-procedural transvalvular gradient changes. Methods: We conducted a single-center retrospective cohort study of 693 patients who underwent TAVI between 2011 and 2023 with complete echocardiographic and anesthesia data. Patients were categorized into four groups by sex and anesthesia type: GA-Male, MAC-Male, GA-Female, and MAC-Female. Hemodynamic, anesthetic, echocardiographic characteristics, and 6-month outcomes were compared. Results: Significant differences were observed across the four sex-anesthesia groups in several hemodynamic and echocardiographic measures. Initial analyses showed that female patients had significantly higher 24 h post-TAVI transvalvular mean gradient delta values compared to males, and among MAC patients, females also had higher 30-day mean gradients. However, secondary analyses revealed that valve size differed significantly between groups and was a key driver of these hemodynamic differences. After adjusting for valve size in a multivariable regression model, gradient differences between groups were no longer statistically significant. Net fluid balance and vasopressor use were more strongly associated with anesthesia type than sex, with GA groups requiring greater support. No significant differences in 6-month cardiovascular outcomes were observed. Conclusions: Early post-TAVI transvalvular gradient changes appeared to be primarily influenced by valve size rather than sex or anesthesia type alone. These findings suggest previously observed sex-based differences may reflect underlying disparities in valve sizing, highlighting need for further prospective studies assessing the independent contributions of sex, anesthesia modality, and valve size on early valve performance/long-term outcomes. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges)
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11 pages, 708 KB  
Article
The Role of 6-Hour ECG in Patients with Left Bundle Branch Block After TAVI in Determining Same-Day Discharge
by Muntaser Omari, Saif Memon, Debbie Stewart, Mohamed Ali, Richard Edwards, Rajiv Das, Timothy Cartlidge, Azfar Zaman, Mohamed Farag and Mohammad Alkhalil
J. Clin. Med. 2025, 14(15), 5408; https://doi.org/10.3390/jcm14155408 - 31 Jul 2025
Viewed by 605
Abstract
Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development [...] Read more.
Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development of LBBB in patients undergoing TAVI. Methods: This is a prospective single-centre study of patients who have LBBB following elective TAVI procedures. All patients underwent ECGs pre-TAVI, as well as immediately, 6 h, and 24 h post-TAVI. Changes in ECG were compared at 6 and 24 h with the one immediately post TAVI. Results: The study included 115 patients with uncomplicated procedures. The mean age was 81 ± 7 years, with 54% male. A self-expanding valve was used in 67% of patients. Following TAVI, prolongations of PR interval and QRS duration were dynamic and reduced at 6 h. The change in PR interval at 6 and 24 h was comparable [−11 (−20 to 3) vs. −2 (−24 to 16) ms, p = 0.18]. Similarly, there was no statistical difference in the change of QRS duration at 6 and 24 h compared to the ECG immediately post-TAVI [−10 (−40 to −2) vs. −7 (−34 to 0) ms, p = 0.055]. Changes in ECG were also comparable in patients undergoing balloon-expandable and self-expanding valves. Conclusions: The current study supports that 6-hour ECG has the potential to reduce the need for prolonged continuous monitoring post-TAVI. ECG at 6 h can help optimise patient flow and facilitate early discharge. Future studies with larger sample sizes are required to confirm our findings. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges)
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11 pages, 509 KB  
Article
Impact of Right Heart Failure on Outcomes of Transcatheter Aortic Valve Implantation: Insights from the National Inpatient Sample
by Sajog Kansakar, Waqas T. Qureshi, Nava Raj Sharma, Dhan Bahadur Shrestha, Jurgen Shtembari, Vijay Shetty, Norbert Moskovits, Khagendra Dahal, Jishanth Mattumpuram and Daniel H. Katz
J. Clin. Med. 2025, 14(3), 841; https://doi.org/10.3390/jcm14030841 - 27 Jan 2025
Viewed by 1461
Abstract
Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We [...] Read more.
Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We analyzed the National Inpatient Sample data from 2018 to 2022. The International Classification of Diseases–Tenth Revision (ICD-10) codes were used to define the patient cohorts. Propensity score weighting was used to balance patient demographic, hospital-level, and comorbidity data. Results: From 2018 to 2022, there were 383,860 TAVI admissions, among which 1915 (0.50%) had the presence of RHF. Compared to patients without RHF, mortality was higher in patients with RHF (7.57% vs. 1.11%, p < 0.01). Similarly, acute kidney injury (37.10% vs. 8.56%, p < 0.01), respiratory failure (12.79% vs. 1.91%, p < 0.01), and use of mechanical circulatory support (11.48% vs. 0.83%, p < 0.01) was higher in the cohort with RHF. Median length of stay (7 days vs. 2 days, p < 0.01) and hospitalization charges ($257,239 vs. $180,501, p < 0.01) were higher in patients with RHF. Conclusions: In conclusion, we report that RHF is associated with increased mortality risk, complications, and resource utilization in patients undergoing TAVI. Right ventricular function should be a part of the evaluation for TAVI, given significantly elevated risks associated with its presence. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges)
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Review

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19 pages, 1853 KB  
Review
Embolic Protection Devices in Transcatheter Aortic Valve Implantation: A Narrative Review of Current Evidence
by George Latsios, Nikolaos Ktenopoulos, Anastasios Apostolos, Leonidas Koliastasis, Ioannis Kachrimanidis, Panayotis K. Vlachakis, Odysseas Katsaros, Emmanouil Mantzouranis, Sotirios Tsalamandris, Maria Drakopoulou, Andreas Synetos, Constantina Aggeli, Konstantinos Tsioufis and Konstantinos Toutouzas
J. Clin. Med. 2025, 14(12), 4098; https://doi.org/10.3390/jcm14124098 - 10 Jun 2025
Cited by 1 | Viewed by 1101
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as a transformative therapy for patients with severe aortic stenosis (AS) across all surgical risk groups. However, periprocedural cerebrovascular events (CVEs), including overt stroke and silent cerebral embolism, remain significant complications. As a result, the use [...] Read more.
Transcatheter aortic valve implantation (TAVI) has emerged as a transformative therapy for patients with severe aortic stenosis (AS) across all surgical risk groups. However, periprocedural cerebrovascular events (CVEs), including overt stroke and silent cerebral embolism, remain significant complications. As a result, the use of embolic protection devices (EPDs) during TAVI has been proposed to mitigate this risk. Our aim was to provide a comprehensive review of the current evidence on the efficacy, safety, and clinical utility of embolic protection devices in TAVI procedures. According to the existing literature, EPDs are effective in capturing embolic debris during TAVI and are associated with a reduction in silent cerebral lesions as detected by diffusion-weighted MRI. While some RCTs and meta-analyses demonstrate a potential benefit in reducing disabling stroke, evidence for a consistent reduction in overall stroke or mortality remains inconclusive. Subgroup analyses suggest the greatest benefit in patients at elevated stroke risk, while current-generation EPDs demonstrate high technical success and an acceptable safety profile. Subsequently, EPDs represent a promising adjunct to TAVI, particularly in high-risk populations. However, routine use in all patients is not yet supported by consistent clinical evidence. Further large-scale trials and long-term outcome data are needed to clarify their role in improving neurological outcomes and to guide selective patient application. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges)
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17 pages, 2755 KB  
Review
Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects
by Milos Brankovic and Abhishek Sharma
J. Clin. Med. 2025, 14(6), 1844; https://doi.org/10.3390/jcm14061844 - 9 Mar 2025
Cited by 3 | Viewed by 3127
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, particularly in patients at high risk of adverse events for traditional open-heart surgery. Since the early 2000s, TAVR has evolved rapidly with advancements in device technology, procedural techniques, and patient selection [...] Read more.
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, particularly in patients at high risk of adverse events for traditional open-heart surgery. Since the early 2000s, TAVR has evolved rapidly with advancements in device technology, procedural techniques, and patient selection criteria. Over the past 20 years, this catheter-based procedure has significantly improved patient survival and quality of life, demonstrating both the safety and efficacy of TAVR, even in patients at low surgical risk. This paper reviews the latest advances in valve design and strategies for treating aortic stenosis. It explores the challenges with long-term outcomes given the younger age of patients undergoing TAVR and the prospects of emerging technologies to improve long-term outcomes. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: Prospects and Challenges)
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