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Transcatheter Aortic Valve Replacement in the Clinical Management of Heart Valve Disease

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

Deadline for manuscript submissions: closed (31 May 2025) | Viewed by 2540

Special Issue Editor


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Guest Editor
Division of Cardiology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan
Interests: myocardial infarction; coronary artery diseases; transcatheter aortic valve replacement; heart valve disease

Special Issue Information

Dear Colleagues,

It has been over 20 years since the late Dr. Alain Cribier performed the first transcatheter aortic valve implantation (TAVI). Advances in device technology and procedural techniques have significantly enhanced the safety of TAVI over time. Today, TAVI is increasingly the treatment of choice, regardless of the surgical risk.

While numerous compelling studies have been conducted and new findings are reported daily, many clinical questions remain unanswered. What is the optimal use of balloon-expandable versus self-expanding transcatheter heart valves? What new roles can imaging modalities such as CT and MRI play in preprocedural risk assessments? How can stroke prevention best be achieved with cerebral embolic protection devices? What are the optimal techniques and pre-procedural assessments for valve-in-valve procedures, including TAV-in-TAV? What are the best treatment strategies for patients with challenging anatomy, such as hemodialysis patients and those requiring alternative approaches? How can we leverage artificial intelligence to enhance the TAVI procedure?

In this Special Issue, our goal is to present cutting-edge advancements in the established field of TAVI and to address the challenges that remain. We would like to invite all researchers involved in TAVI to contribute original articles and comprehensive reviews for the further advancement of this field and to share new knowledge. Together, we will push the boundaries of TAVI, fostering further progress in the field and sharing groundbreaking insights.

Dr. Masahiko Asami
Guest Editor

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Keywords

  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement
  • preprocedural imaging assessments
  • valve-in-valve procedure
  • alternative approaches
  • cerebral embolic protection devices
  • challenging anatomy
  • artificial intelligence

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Published Papers (2 papers)

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Research

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12 pages, 9892 KiB  
Article
Alternative Transaxillary Access for Transcatheter Aortic Valve Implantation
by Konrad Wisniewski, Gerrit Kaleschke, Fernando De-Torres-Alba, Sven Martens and Heinz Deschka
J. Clin. Med. 2025, 14(14), 5127; https://doi.org/10.3390/jcm14145127 - 18 Jul 2025
Viewed by 329
Abstract
Background/Objectives: Currently, the transfemoral approach is recognized as the primary method for accessing transcatheter aortic valve implantation (TAVI). However, alternative techniques are needed when the transfemoral access is not suitable. We proposed that a modified transaxillary approach through the distal left axillary artery [...] Read more.
Background/Objectives: Currently, the transfemoral approach is recognized as the primary method for accessing transcatheter aortic valve implantation (TAVI). However, alternative techniques are needed when the transfemoral access is not suitable. We proposed that a modified transaxillary approach through the distal left axillary artery is both viable and safe for conducting TAVI, potentially offering benefits for patients. Methods: From December 2018 to February 2024, a total of 24 patients (7 women, average age 77.9 ± 8 years) received TAVI using transaxillary access via the left axillary artery. The participants suffered from symptomatic severe aortic stenosis and were deemed TAVI candidates with iliofemoral anatomy unsuitable for a transfemoral route. The patient group displayed a high perioperative risk profile, with significant peripheral artery disease or severe obstructive infrarenal aortic conditions. The implantation of the aortic prosthesis was carried out through the left distal axillary artery. A balloon-expandable valve was used in every instance. Results: In the examined cohort, the 30-day mortality rate was 4.2%. A new pacemaker was necessary for four patients (16.7%). One case exhibited a new moderate neurological dysfunction. Additionally, one patient required surgical revision of the access point due to ischemia. Conclusions: Our findings indicate that transaxillary TAVI via the distal left axillary artery has yielded encouraging outcomes. This approach is practicable and safe, does not prolong the procedure, minimizes surgical trauma, ensures excellent access regardless of chest anatomy, and is sparing for the brachial plexus. As a single-center pilot study, our findings require confirmation in larger, prospective cohorts with extended follow-up to fully validate the safety and long-term efficacy of this technique. Full article
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Review

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29 pages, 2845 KiB  
Review
Access Options for Transcatheter Aortic Valve Replacement
by Jeffrey Chidester, Teodora Donisan, Parth V. Desai, Sukriti Banthiya, Ahmed Zaghloul, Michael E. Jessen, Ki Park, Weiyi Tan, Shirling Tsai, Lynn Huffman, Anthony A. Bavry, Dharam J. Kumbhani and Amit Goyal
J. Clin. Med. 2025, 14(5), 1651; https://doi.org/10.3390/jcm14051651 - 28 Feb 2025
Viewed by 1692
Abstract
Transcatheter aortic valve replacement (TAVR) was introduced in 2002 and has become integral in the management of aortic stenosis. As an alternative to surgical aortic valve replacement, it relies heavily on safe access to the aortic annulus for implantation of a valve prosthesis. [...] Read more.
Transcatheter aortic valve replacement (TAVR) was introduced in 2002 and has become integral in the management of aortic stenosis. As an alternative to surgical aortic valve replacement, it relies heavily on safe access to the aortic annulus for implantation of a valve prosthesis. Throughout its development and in current practice, the transfemoral (TF) arterial route for retrograde valve delivery has been the primary approach. However, this route is not appropriate for all patients, which has led to the development of multiple alternate access options. This review discusses the development of access for TAVR, followed by a thorough discussion of TF access. The commercially available products, preprocedural planning, closure techniques, and procedural complications are all discussed. We also describe the various alternate access routes with particular emphasis on the most recently developed route, transcaval access (TCv), with focus on procedural indications, technical considerations, and comparative outcomes. As TAVR technology, indications, and availability all expand, the knowledge and implementation of safe access are of utmost importance. Full article
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