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Recent Developments in Transcatheter Aortic Valve Implantation
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Recent Developments in Transcatheter Aortic Valve Implantation

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

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 5331

Special Issue Editor

Dr. Edward James Frazer Danson

E-Mail Website
Guest Editor
The Cardiac Centre NSW, 3 Rawson St, Wollongong, NSW 2500, Australia
Interests: cardiac catheterisation; coronary angioplasty; TAVI; coronary interventions; aortic valve interventions; echocardiogram

Special Issue Information

Dear Colleagues,

Aortic stenosis (AS) is a common heart valve disease that can lead to heart failure and death. For patients with AS, valve repair or replacement surgery has historically been the mainstay of treatment, given that medical treatments have no proven benefit. However, transcatheter aortic valve implantation (TAVI) is increasingly becoming a preferred treatment option when compared to surgery, particularly for patients at an advanced age or those with comorbidities, as recovery from the treatment is typically much quicker.

TAVI is a minimally invasive treatment, as biological valve implantation is performed percutaneously (on top of the diseased valve without its removal) via an intra-arterial sheath. This technology has evolved over the past 20 years to be equivalent in terms of safety and efficacy to aortic surgery with up to 10 years follow-up. There are also numerous advantages for patients and healthcare systems,  including abbreviated hospitalisation periods for treatment, less perioperative discomfort, and quicker recovery times.

This Special Issue aims to promote academic exchanges, progress the field of TAVI, and promote the widespread application of this technology in the treatment of heart valve diseases, including in more complex patient cases and scenarios.

Dr. Edward James Frazer Danson
Guest Editor

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

  • transcatheter aortic valve implantation
  • TAVI
  • aortic valve stenosis
  • interventional cardiac surgery
  • heart valve disease

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Published Papers (3 papers)

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Research

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12 pages, 1033 KiB  
Article
Zero-Contrast Transcatheter Aortic Valve Implantation vs. Standard Practice: Periprocedural and Long-Term Clinical Outcomes
by Roberto Nerla, Elisa Mikus, Angela Sanseviero, Angelo Squeri, Simone Calvi, Carlo Savini, Diego Sangiorgi and Fausto Castriota
J. Clin. Med. 2024, 13(18), 5405; https://doi.org/10.3390/jcm13185405 - 12 Sep 2024
Viewed by 1117
Abstract
Background: We aimed to compare the procedural efficacy and long-term clinical results of a totally contrast-free Transcatheter Aortic Valve Implantation (TAVI) procedure (i.e., contrast dye was not used for either the pre-procedural assessment or during the procedure) to those of standard practice [...] Read more.
Background: We aimed to compare the procedural efficacy and long-term clinical results of a totally contrast-free Transcatheter Aortic Valve Implantation (TAVI) procedure (i.e., contrast dye was not used for either the pre-procedural assessment or during the procedure) to those of standard practice in patients with severe renal dysfunction. Methods: All consecutive patients with a glomerular filtration rate (GFR) ≤ 35 mL/min and severe aortic stenosis who were treated with transfemoral TAVI at our Institution were included in the registry. The zero-contrast patients underwent carbon dioxide angiography and a non-contrast CT scan for assessment of vascular access suitability, and aortic annulus sizing was performed by a TEE, and the procedural guidance was fluoroscopic and echocardiographic. Procedural outcomes were evaluated, and clinical long-term follow-up was performed for all included patients. Results: A total of 44 patients (median age, 85 (IQR, 80.75–87.00)) were included in the zero-contrast group (TEE guidance and general anesthesia in 37 (84%) patients), while 63 patients were included in the standard practice arm (82 ± 78 mL of contrast dye used). Procedural success was obtained in 100% of cases. There were no differences in procedural outcomes, including final mean aortic gradients (5.5 (IQR, 5.0–10.0) mmHg in the zero-contrast group vs. 6.0 (IQR, 5.0–10.0) mmHg in the standard practice group) and rate of at least a moderate paravalvular leak (0% vs. 1.6% in the zero-contrast and standard practice groups, respectively; p = 0.31). No differences in AKI during the hospital stay were observed. Over a median follow-up of 3.3 years, there was a significantly lower rate of AKI (1.2% vs. 25.9%, p < 0.001) and rehospitalizations (1.6% vs. 35.5%, p < 0.00) in standard practice group. Conclusions: We showed for the first time the feasibility and efficacy of a totally contrast-free strategy compared to standard practice in TAVI patients with severe renal dysfunction. Besides achieving comparable procedural results, the zero-contrast strategy showed a better long-term clinical outcome in reducing hospital readmissions for kidney function deterioration. Full article
(This article belongs to the Special Issue Recent Developments in Transcatheter Aortic Valve Implantation)
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13 pages, 1282 KiB  
Article
Platelet Reduction after Transcatheter Aortic Valve Implantation: Results from the PORTRAIT Study
by Federica Jiritano, Michele Di Mauro, Giuseppe Filiberto Serraino, Pasquale Mastroroberto, Elena Caporali, Enrico Ferrari, Mariusz Kowalewski, Roberto Scrofani, Leonardo Patanè, Giuseppe Visicchio, Domenico Paparella, Giosuè Falcetta, Andrea Colli, Matteo Matteucci, Giangiuseppe Cappabianca, Francesco Pollari, Theodor Fischlein and Roberto Lorusso
J. Clin. Med. 2024, 13(6), 1579; https://doi.org/10.3390/jcm13061579 - 10 Mar 2024
Cited by 2 | Viewed by 1568
Abstract
Background: An unexplained condition that follows transcatheter aortic valve implantation (TAVI) is platelet count reduction (PR). According to published research, patients with balloon-expandable valves (BEVs) had a greater PR than those with self-expandable valves (SEVs). Objectives: The purpose of this study was to [...] Read more.
Background: An unexplained condition that follows transcatheter aortic valve implantation (TAVI) is platelet count reduction (PR). According to published research, patients with balloon-expandable valves (BEVs) had a greater PR than those with self-expandable valves (SEVs). Objectives: The purpose of this study was to investigate the incidence and clinical effects of PR following TAVI. Methods: In total, 1.122 adult TAVI patients were enrolled. Propensity score matching was carried out in a 1:1 ratio between patients with BEVs and those with SEVs. The analysis included changes in platelet count, in-hospital mortality, and early postoperative adverse events. Results: Notably, 632 patients were matched (BEV:316; SEV:316). All patients’ post-procedural platelet counts changed according to a parabolic curve, using a mixed regression model for repeated analyses (estimate = −0.931; standard error = 0.421; p = 0.027). The platelet count varied comparably in patients with BEVs and SEVs (estimate = −4.276, standard error = 4.760, p = 0.369). The average time for obtaining the nadir platelet count value was three days after implantation (BEV: 146 (108–181) vs. SEV: 149 (120–186); p = 0.142). Overall, 14.6% of patients (92/632) had post-procedural platelet count <100,000/µL. There was no difference between the two prosthesis types (BEV:51/316; SEV:41/316; p = 0.266). Thrombocytopenia was found to be significantly linked to blood product transfusions, lengthier stays in the intensive care unit and hospital, and in-hospital mortality. Conclusions: TAVI, irrespective of the type of implanted valve, is linked to a significant but temporary PR. Thrombocytopenia increases the risk of serious complications and in-hospital death in TAVI patients. To explore and clarify the causes and associated effects, further prospective research is necessary. Full article
(This article belongs to the Special Issue Recent Developments in Transcatheter Aortic Valve Implantation)
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Review

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14 pages, 14735 KiB  
Review
Exploring Optimal Strategies for Surgical Access in Transcatheter Aortic Valve Implantation
by Rushmi Purmessur, Zeba Ahmed and Jason Ali
J. Clin. Med. 2024, 13(16), 4655; https://doi.org/10.3390/jcm13164655 - 8 Aug 2024
Viewed by 1963
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced [...] Read more.
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of severe aortic stenosis, particularly for patients deemed high risk or inoperable for traditional surgical aortic valve replacement. The transfemoral approach is the preferred route whenever feasible, attributed to its minimally invasive nature, reduced procedural morbidity, and shorter recovery times. In total, 80–90% of TAVI procedures are performed via the transfemoral route. However, anatomical constraints such as severe peripheral arterial disease, small vessel diameter, or significant vessel tortuosity can preclude the use of this access site. In such cases, alternative access strategies must be considered to ensure the successful implantation of the valve. This review aims to provide a comprehensive summary of the various surgical techniques available for TAVI access, exploring the rationale, technical aspects, and challenges associated with each method. We will explore alternative routes, including the transapical, transaortic, transaxillary, and transcarotid approaches, highlighting their respective benefits and limitations. Full article
(This article belongs to the Special Issue Recent Developments in Transcatheter Aortic Valve Implantation)
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