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Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions

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

Deadline for manuscript submissions: 20 May 2026 | Viewed by 11318

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Special Issue Editors

Dr. Alon Shechter

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Guest Editor

1. Department of Cardiology, Rabin Medical Center, Petach Tikva 4941492, Israel
2. Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
Interests: echocardiography; valvular heart disease; structural heart interventions; transcatheter edge-to-edge repair; transcatheter aortic valve implantation

Dr. Pablo Codner

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Guest Editor

1. Department of Cardiology, Rabin Medical Center, Petach-Tikva 4941492, Israel
2. Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
Interests: interventional cardiology; valvular heart disease; transcatheter edge-to-edge repair; transcatheter aortic valve implantation

Special Issue Information

Dear Colleagues,

Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of patients with aortic valve disorders. Paralleling improvements in device design and delivery, operator experience, imaging guidance, supportive treatment, and risk stratification, the procedure has gradually assumed a central therapeutic role across a wide range of clinical scenarios and patient profiles. In this Special Issue of the Journal of Clinical Medicine, we aim to provide readers with an updated overview of the diagnostic, prognostic, and technical aspects related to TAVI, and further highlight remaining challenges and future directions in this breakthrough intervention. Both original research and review articles dealing with any of these topics are most welcome.

Dr. Alon Shechter
Dr. Pablo Codner
Guest Editors

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Keywords

transcatheter aortic valve implantation
transcatheter aortic valve replacement
aortic valve stenosis
aortic valve regurgitation
aoric valve disease
cardiac imaging
artifical intelligence
machine learning

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Published Papers (9 papers)

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Research

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9 pages, 1199 KB

Open AccessArticle

Dynamic Changes in Circulating Osteogenic Progenitor Cells Following TAVI: Implications for Vascular Remodeling—EPC and EPC-OCN Dynamics After TAVI

by Lia Schoenfeld, Pablo Codner, Merry Abitbol, Ben Cohen, Dorit Leshem Lev, Amos Levi, Ariel Nakache, Guy Witberg, Yeela Talmor Barkan, Ran Kornowski and Leor Perl

J. Clin. Med. 2026, 15(7), 2752; https://doi.org/10.3390/jcm15072752 - 5 Apr 2026

Viewed by 390

Abstract

Background: The prevalence of severe aortic stenosis (AS) is increasing, in accordance with a longer life expectancy. Aortic valve calcification is a multifactorial pathological process involving a complex interplay between different types of regenerative cellular and genetic factors. Among these cells, endothelial progenitor cells (EPCs) and their osteoblastic phenotype subpopulation (EPC-OCNs) have been implicated in vascular remodeling and disease progression. Objectives: To assess longitudinal changes in EPC and EPC-OCN levels in patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI). Methods: In this prospective observational study, 65 patients with severe AS undergoing TAVI were enrolled. Circulating EPC and EPC-OCN levels were quantified by flow cytometry before the procedure, at 4 ± 1 days, and at 90 ± 29 days after TAVI. EPCs were defined by expression of CD133, CD34, and VEGFR-2. Results: Circulating EPC levels remained unchanged throughout the follow-up. In contrast, circulating EPC-OCNs increased significantly over time. Specifically, CD133+/VEGFR-2+/OCN+ cells rose from 2.50% to 6.25%, CD34+/VEGFR-2+/OCN+ from 2.04% to 4.05%, and VEGFR-2+/OCN+ from 1.46% to 3.01% (all p < 0.01). This suggests an osteogenic response to TAVI, while classical endothelial repair mechanisms were not systemically activated. Conclusions: EPC-OCNs increased significantly following TAVI, possibly reflecting ongoing tissue remodeling or calcification processes. In contrast, the stability of classical EPCs levels suggests limited systemic endothelial regeneration. These observations underscore the potential role of EPC-OCNs as markers or modulators of pre- and post-TAVI vascular remodeling. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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12 pages, 731 KB

Open AccessArticle

Procedural and Device Neutrality of Post-TAVI Renal Outcomes: A Multivariable Analysis of Valve Type, Size, and Anatomy

by Rosa Alba Pugliesi, Shu Fon Muna, Andreas H. Mahken, Nour Maalouf, Georgios Chatzis and Jonas Apitzsch

J. Clin. Med. 2026, 15(6), 2175; https://doi.org/10.3390/jcm15062175 - 12 Mar 2026

Viewed by 362

Abstract

Background: Renal dysfunction remains a frequent complication after transcatheter aortic valve implantation (TAVI). Although contrast exposure and baseline renal impairment are established risk factors, the influence of structural valve characteristics, including valve diameter and prosthesis platform, on early renal outcomes is not well defined. This study evaluated whether valve size and valve platform independently affect early post-procedural renal function. Methods: This retrospective cohort study included 410 consecutive patients undergoing TAVI between 2018 and 2021 with complete pre- and post-procedural renal biomarker data. Of these, 371 patients with complete covariate data were analyzed in multivariable models. Serum creatinine and estimated glomerular filtration rate (eGFR) were assessed within 72 h before and after TAVI. Renal function change was calculated as absolute differences. Acute kidney injury (AKI) was defined according to KDIGO criteria. Correlation analyses and multivariable linear and logistic regression models were performed. Results: Median valve diameter was 26 mm (IQR 26–29). Renal function remained largely stable, with a median creatinine change of −0.06 mg/dL and median eGFR change of +4.0 mL/min/1.73 m². Valve diameter was not associated with creatinine change (ρ = −0.047, p = 0.330) or eGFR change (ρ = 0.053, p = 0.278). KDIGO-defined AKI occurred in 56 patients (13.7%) and did not differ by valve platform (p = 0.719) or diameter tertiles (p = 0.204). Conclusions: Valve diameter and platform were not independently associated with early renal outcomes after TAVI. Baseline renal function and contrast exposure were the principal determinants of post-procedural renal trajectory. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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11 pages, 451 KB

Open AccessArticle

Aortic Valve Replacement vs. Balloon-Expandable and Self-Expandable Transcatheter Implantation in Low-Risk Patients

by Vittoria Lodo, Enrico Giuseppe Italiano, Luca Weltert, Edoardo Zingarelli, Cristina Viscido, Gabriella Buono and Paolo Centofanti

J. Clin. Med. 2025, 14(23), 8278; https://doi.org/10.3390/jcm14238278 - 21 Nov 2025

Viewed by 823

Abstract

Objectives: This study sought to compare midterm outcomes of low-risk patients who underwent a surgical aortic valve replacement (SAVR) vs. balloon-expandable (BE) or self-expandable (SE) transcatheter aortic valve implantation (TAVI). Methods: Data on consecutive patients undergoing SAVR or transfemoral TAVI between 2017 and 2022 were collected. Patients were separated into three groups according to the type of prosthesis: a biological surgical prosthesis, BE prosthesis and SE prosthesis. The three groups were compared in terms of baseline characteristics, post-procedural outcomes and long-term survival. Results: A total of 542 patients were enrolled, and 221 received a surgical prothesis, 150 received a BE prosthesis and 171 received an SE prosthesis. TAVI patients were older and had a higher risk profile compared to surgical patients. Propensity score matching resulted in an excellent matching of nearly 80 patients in each group. In the matched cohort, SE prostheses were associated with a significantly higher incidence of stroke (SE group 6.3%, BE group 0, SAVR group 2.3%, p = 0.045), para-valvular leak (SE group 8.1%, BE group 2.4%, SAVR group 0, p = 0.017) and left bundle branch block (SE group 23.8%, BE group 18.2%, SAVR group 0%, p < 0.001). Regarding 5-year mortality, no significant differences were reported between the BE and SE TAVI (13.6% vs. 22.5%, p = 0.066). However, when comparing surgery versus TAVI, the SE prosthesis showed a significantly higher 5-year mortality (22.5% vs. 11.6%, p = 0.042). Instead, the BE prosthesis demonstrated its non-inferiority compared to the surgical prosthesis (13.6% vs. 11.6%, p = 0.249). Conclusions: The BE prosthesis should be considered the prosthesis of choice for patients with a long life expectancy requiring a transcatheter procedure. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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13 pages, 2740 KB

Open AccessArticle

Standard Percutaneous Transluminal Angioplasty Versus Intravascular Lithotripsy to Facilitate Trans-Femoral Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis and Severe Peripheral Arterial Disease

by David Belkin, Tamir Bental, Tullio Palmerini, Ran Kornowski and Pablo Codner

J. Clin. Med. 2025, 14(17), 6335; https://doi.org/10.3390/jcm14176335 - 8 Sep 2025

Viewed by 851

Abstract

Background/Objectives: The optimal method to facilitate femoral access in patients with aortic stenosis and severe peripheral arterial disease (PAD) undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study compared the safety and efficacy of percutaneous transluminal angioplasty (PTA) versus Shockwave^® intravascular lithotripsy (IVL) in patients with severe PAD undergoing TAVI via the trans-femoral route enrolled in the Hostile TAVI registry trial. Methods: Patients with severe PAD from 28 international centers were enrolled in the registry. This sub-study analyzed patients who underwent transfemoral TAVI facilitated by PTA (n = 352) or IVL (n = 166). Primary endpoints included rates of survival, major vascular complications, and major bleeding. Outcomes were also stratified according to the severity of PAD using the novel Hostile risk score. Results: Patients in the PTA group were older and had lower rates of prior stroke/TIA. All-cause mortality at 3 years was similar between PTA and IVL groups (34.9% vs. 38.6%; p = 0.27, respectively). However, IVL was associated with fewer major vascular complications (21.7% vs. 13.3%; p = 0.033, respectively), less major bleeding (14.0% vs. 7.0%; p = 0.024, respectively), and shorter hospital stays (7.06 ± 6.69 vs. 4.29 ± 4.78 days; p < 0.001; 95% CI: 1.63–3.91, respectively). Cox regression analysis showed that at low (≤8.5) Hostile Scores, PTA was associated with higher rates of major vascular complications and major bleeding than IVL. Conclusions: In patients with aortic stenosis and severe PAD undergoing TAVI via the transfemoral route, IVL is safer than PTA, with fewer vascular and bleeding complications but similar intermediate-term survival. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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11 pages, 623 KB

Open AccessArticle

A TAVI Programme Without an On-Site Cardiac Surgery Department: A Single-Center Retrospective Study

by Rami Barashi, Mustafa Gabarin, Ziad Arow, Ranin Hilu, Ilya Losin, Ivan Novikov, Karam Abd El Hai, Yoav Arnson, Yoram Neuman, Koby Pesis, Ziyad Jebara, David Pereg, Edward Koifman, Abid Assali and Hana Vaknin-Assa

J. Clin. Med. 2025, 14(15), 5449; https://doi.org/10.3390/jcm14155449 - 2 Aug 2025

Cited by 2 | Viewed by 1661

Abstract

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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11 pages, 1398 KB

Open AccessArticle

Predicting the Burden for Surgical Aortic Valve Replacement in a Tertiary Centre: The Impact of Aged Populations for the Next Decades

by Rafael Maniés Pereira, Nuno Guerra, João Moreira Gonçalves, Ricardo Ferreira, Ângelo Nobre, Dulce Brito, Teresa Ferreira Rodrigues and Tiago R. Velho

J. Clin. Med. 2025, 14(10), 3365; https://doi.org/10.3390/jcm14103365 - 12 May 2025

Viewed by 1225

Abstract

Background/Objectives: The incidence of aortic stenosis (AS) is predicted to rise with the aging population, emerging as a growing public health challenge in developed countries, leading to an increased demand for intervention. Our aim is to predict the evolution of proposed cases for SAVR in the geographic referral area of our tertiary hospital until 2041. Methods: We used data from the Portuguese Census for 2001, 2011, and 2021 to analyze the resident population within the Cardiothoracic Surgery Department’s referral area. Applying population projection methods (rate of geometric growth), we projected demographic trends over 20 years, from 2021 to 2041. Our analysis focused on AS cases who underwent SAVR in our department between 2001–2011 and 2011–2021. Results: Between 2001 and 2021, there was an increase in the overall population, particularly among the elderly (1.4% growth rate in the population ≥ 65 years old). The aging index increased from 128.4 (110.5–180.6) in 2001 to 189.1 (155.9–222.5) in 2021 (p-value < 0.001). Similarly, the longevity index significantly increased between 2001 [42.6 (40.8–44.80)] and 2021 [49.30 (47.7–51.8)] (p-value < 0.001). The number of SAVRs performed increased, with a mean increase of 8.11 surgeries/year (R² = 0.6457, p < 0.001). By 2041, our referral center will increase SAVR by at least 51 surgeries/year in a decreasing growth rate scenario, and 67 surgeries/year in a growth rate stagnation scenario. Conclusions: The ongoing trend of population aging will increase the demand for healthcare resources, particularly within the cardiovascular domain. Accurately assessing the volume of SAVR is imperative for reformulating strategies to address the increasing demand effectively. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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Review

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15 pages, 312 KB

Open AccessReview

The Next Chapter in TAVR: Innovations and the Road Ahead

by Philippe Brouillard, El Hadji Diallo, Walid Ben Ali and Rémi Kouz

J. Clin. Med. 2025, 14(13), 4504; https://doi.org/10.3390/jcm14134504 - 25 Jun 2025

Viewed by 3182

Abstract

Transcatheter aortic valve replacement (TAVR) was first introduced as a minimally invasive treatment for patients with severe aortic stenosis (AS) who are at high or intermediate surgical risk. Recently, its application has expanded to include younger and lower-risk patients, establishing TAVR as a less invasive alternative to surgical aortic valve replacement (SAVR) across the entire surgical spectrum. The expanding utilization of TAVR has driven significant advancements that have greatly enhanced its safety and effectiveness, resulting in a substantial reduction in complications such as paravalvular leak, conduction abnormalities, and periprocedural strokes. Numerous trials have demonstrated the potential superiority of TAVR over conventional surgery in achieving favorable clinical outcomes. Furthermore, the increasing number of long-term trials has provided valuable insight into TAVR outcomes in previously under-studied populations, including patients with complex anatomies. However, significant challenges remain, particularly in ensuring the long-term durability of transcatheter valves, with younger patients likely to outlive their bioprosthetic valves. Consequently, the focus is shifting towards lifetime management strategies, including considerations for coronary re-access, the risk of coronary obstruction, and prosthesis–patient mismatch. This review explores key developments in the field, including TAVR for aortic regurgitation and bicuspid anatomy, the emerging role of TAVR in moderate and asymptomatic AS, and innovations in valve design and procedural planning. We also examine novel imaging tools, adjunctive technologies, and strategies to address coronary access and re-intervention. As long-term data accumulate, these evolving trends will shape the future of TAVR and its role in managing aortic valve disease across increasingly complex clinical scenarios. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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13 pages, 3863 KB

Open AccessSystematic Review

Imaging and Clinical Outcomes with Sentinel Cerebral Embolic Protection During TAVR: A Meta-Analysis of Randomized Trials with Trial Sequential Analysis

by Shanmukh Sai Pavan Lingamsetty, Mangesh Kritya, Priyanka Vatsavayi, Chenna Reddy Tera, Mohamed Doma, Sahas Reddy Jitta, Mohan Chandra Vinay Bharadwaj Gudiwada, Jaswanth Jasti, Adham Ramadan, Venkata Vedantam, Pedro A. Villablanca and Andrew M. Goldsweig

J. Clin. Med. 2026, 15(2), 914; https://doi.org/10.3390/jcm15020914 - 22 Jan 2026

Viewed by 577

Abstract

Background: Stroke and subclinical cerebral ischemia remain important neurological complications of transcatheter aortic valve replacement (TAVR). The Sentinel cerebral embolic protection (CEP) device is designed to capture embolic debris during TAVR, but its impact on clinical and imaging outcomes remains incompletely characterized. Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) comparing Sentinel CEP versus no protection when TAVR was performed. Outcomes of interest included all stroke, disabling stroke, infarct volume by diffusion-weighted MRI in protected and unprotected areas, all-cause mortality, acute kidney injury, and major vascular complications. Risk ratios (RRs) and median differences with 95% confidence intervals (CIs) were calculated using random-effects models and trial sequential analysis (TSA) assessed evidence robustness. Results: Four RCTs including 10,986 patients were analyzed. Sentinel CEP did not significantly reduce clinical stroke (RR 0.88, 95% CI 0.69–1.12) or disabling stroke (RR 0.68, 95% CI 0.41–1.14). Pooled DW-MRI data showed a significant reduction in new ischemic lesion volume within Sentinel CEP-protected territories (difference in medians −75.7 mm³; 95% CI −130.4 to −21.0). Subgroup analyses in elderly, female, and high-surgical-risk patients revealed no benefit with Sentinel CEP. Additionally, TSA indicated that current data are underpowered for definitive conclusions. Conclusions: The Sentinel CEP device during TAVR did not significantly reduce clinical stroke but was associated with lower MRI-detected ischemic lesion volumes compared with no protection. Further adequately powered RCTs integrating clinical and imaging endpoints are needed to define its role in neuroprotection during TAVR. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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13 pages, 6215 KB

Open AccessSystematic Review

Peri-Procedural Continuation Versus Interruption of Anticoagulation for Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

by Jacinthe Khater, Marco Frazzetto, Filippo Luca Gurgoglione, Jasim Hasan, Davide Donelli, Guilherme Attizzani and Bernardo Cortese

J. Clin. Med. 2025, 14(10), 3563; https://doi.org/10.3390/jcm14103563 - 20 May 2025

Cited by 1 | Viewed by 1253

Abstract

Background/Objectives: Oral anticoagulation therapy (OAC) is crucial for reducing the risk of ischemic complications in patients with atrial fibrillation (AF). However, OAC also increases the risk of major bleeding events. The optimal management of OAC in patients with AF undergoing transaortic valve implantation (TAVI) is unclear. This study aimed to compare the efficacy and safety of OAC interruption vs. continuation in patients with AF scheduled for TAVI. Methods: PubMed, EMBASE, and Cochrane were searched to include all pertinent randomized and observational studies. The primary endpoint was the occurrence of net adverse clinical events (NACE), a composite of all-cause death, major vascular complications, and major bleeding at 30-day follow-up. Secondary endpoints included all-cause death, cardiovascular death, major vascular complications, major bleeding, any bleeding, stroke, non-fatal myocardial infarction, and the need for red-packed blood transfusion. Results: A total of three studies and 2773 patients were included in the analysis (1314 were allocated to continuation of OAC therapy and 1459 to interruption of OAC therapy during TAVI). The two study groups experienced a similar rate of NACE (OR = 0.89 [95% CI 0.61 to 1.31], I² = 77%, p = 0.56) compared to the OAC-interruption group. No significant differences were observed in the rate of all-cause death (p = 0.21), cardiovascular death (p = 0.35), major vascular complications (p = 0.84), major bleeding events (p = 0.47), total bleeding events (p = 0.62), or non-fatal MI (p = 0.55). Interestingly, the OAC-continuation group experienced a lower occurrence of stroke (OR = 0.62 [95% CI 0.39 to 0.97], I² = 0%, p = 0.04) and the need for red packed blood cells (OR = 0.66 [95% CI 0.50 to 0.86], I² = 20%, p < 0.01) compared to the OAC-interruption group. Conclusions: In patients with AF undergoing TAVI, there was no significant difference between interruption and continuation of OAC in terms of NACE, composite of all-cause death, major vascular complications, or major bleeding at 30-day follow-up. Of interest, the OAC-continuation group patients experienced lower rates of stroke and the need for blood transfusion. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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