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Clinical Advances in Transcatheter Aortic Valve Replacement
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Clinical Advances in Transcatheter Aortic Valve Replacement

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

Deadline for manuscript submissions: closed (5 September 2024) | Viewed by 7111

Special Issue Editor

Dr. Gry Dahle

E-Mail Website
Guest Editor
Department of Cardiothoracic surgery, Oslo University Hospital, 0372 Oslo, Norway
Interests: transcatheter therapies; mini-invasive surgery; innovations; implementing new methods and ethics

Special Issue Information

Dear Colleagues,

It has now been 22 years since the first transcatheter aortic valve implantation (TAVI) implant. The indications have moved from high-risk to low-risk, as have younger patients. There has been a huge evolution in valve development and delivery systems, imaging, and procedural strategy. Still, we have the issue of durability: “Who lives longer, the valve or the patient”? With TAVI in younger patients, bicuspid valves and aortic regurgitation have to be addressed. The explant of a TAVI valve may be hazardous, but it is an increasing trend in the US.

These topics will be discussed by the opinion leaders in this Special Issue.

Dr. Gry Dahle
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

  • how far can we expand TAVI to SAVR
  • the increasing number and results of TAVI explants
  • TAVI in bicuspid valves
  • TAVI solutions for aortic regurgitation
  • TAVI in low risk vs. younger patients
  • the role of artificial intelligence for TAVI planning
  • peri procedural care for TAVI patients

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Published Papers (4 papers)

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Research

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10 pages, 1729 KiB  
Article
German Experience with a Novel Balloon-Expandable Heart Valve Prosthesis for Transcatheter Aortic Valve Implantation—Outcomes of the MYLAND (MYvaL germAN stuDy) Study
by Timm Ubben, Eike Tigges, Won-Keun Kim, Andreas Holzamer, Ingo Breitenbach, Ralf Sodian, Jürgen Rothe, Willibald Hochholzer, Samer Hakmi and Franz-Josef Neumann
J. Clin. Med. 2024, 13(11), 3163; https://doi.org/10.3390/jcm13113163 - 28 May 2024
Cited by 1 | Viewed by 1363
Abstract
Background: The primary objective of this study was to evaluate the initial experience in Germany with the Meril Myval™ (MM) transcatheter heart valve (THV) system for the treatment of severe symptomatic aortic valve stenosis. The MM THV is a novel balloon-expandable valve with [...] Read more.
Background: The primary objective of this study was to evaluate the initial experience in Germany with the Meril Myval™ (MM) transcatheter heart valve (THV) system for the treatment of severe symptomatic aortic valve stenosis. The MM THV is a novel balloon-expandable valve with an expanded sizing matrix. Contemporary patients undergoing TAVI with the established Edwards Sapien™ (ES) THV served as the comparator group. Methods: Between 1st March and 31 August 2020 a total of 134 patients (33% female, 80.1 ± 6.7 years; EuroScore II 4.7 ± 4.8) underwent TAVI with an MM (95% transfemoral) for severe aortic stenosis at six German tertiary care centers. Results: Correct positioning of the THV was achieved in 98.5% (n = 132). Mean aortic gradients (MPG) were reduced from 42 ± 14 mmHg to 11 ± 5 mmHg. Mild postprocedural paravalvular leak (PVL) was observed in 62% (n = 82) patients, whereas only one patient had more than mild PVL. New permanent pacemaker implantation (PPI) was indicated in 15 patients (11%). Major vascular complications occurred in 6.7% (n = 9) patients. The in-hospital combined incidence of all-cause death and stroke was 4.5% (n = 6). In the comparator group that included 268 patients, the 30-day incidences of PPI, major vascular complications, and the composite of all-cause death and stroke were 16%, 1.9%, and 7.1%, respectively; MPGs were reduced from 44 ± 15 mmHg to 12.8 ± 4.6 mmHg and the more than mild PVL occurred in 0.7%. Conclusions: The MM is a promising novel THV system, with performance comparable to the established ES THVs. These findings await confirmation by ongoing randomized trials. Full article
(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)
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Review

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10 pages, 1872 KiB  
Review
Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis—We Need a Well-Designed Randomized Control Trial
by Kendra J. Grubb, Stephanie K. Tom, Joe Xie, Kanika Kalra and Anton Camaj
J. Clin. Med. 2024, 13(21), 6565; https://doi.org/10.3390/jcm13216565 - 31 Oct 2024
Cited by 2 | Viewed by 1037
Abstract
Bicuspid aortic stenosis is a common pathology, typically seen in patients a decade younger than those with tricuspid valves. Surgical aortic valve replacement has been the mainstay treatment for bicuspid disease, especially considering the prevalence of concomitant aortic aneurysmal pathology. Transcatheter aortic valve [...] Read more.
Bicuspid aortic stenosis is a common pathology, typically seen in patients a decade younger than those with tricuspid valves. Surgical aortic valve replacement has been the mainstay treatment for bicuspid disease, especially considering the prevalence of concomitant aortic aneurysmal pathology. Transcatheter aortic valve replacement has shown equivalent results in bicuspid compared to tricuspid pathology in highly selected patient populations in single-arm registries and observational studies. For older patients with favorable bicuspid pathology, TAVR is reasonable. However, as younger patients with longer life expectancy are now being treated with TAVR, what is “best” is a question only answered by a well-designed randomized controlled trial. Herein, we describe the current evidence for treating bicuspid aortic stenosis and provide a framework for future trials. Yet, the question of equipoise remains, and who will we enroll? Full article
(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)
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17 pages, 1449 KiB  
Review
Who Lives Longer, the Valve or the Patient? The Dilemma of TAVI Durability and How to Optimize Patient Outcomes
by Vincenzo Cesario, Omar Oliva, Chiara De Biase, Alessandro Beneduce, Mauro Boiago, Nicolas Dumonteil and Didier Tchetche
J. Clin. Med. 2024, 13(20), 6123; https://doi.org/10.3390/jcm13206123 - 14 Oct 2024
Cited by 1 | Viewed by 1379
Abstract
Over the past few years, transcatheter aortic valve implantation (TAVI) imposed itself as the first-choice therapy for symptomatic aortic stenosis (AS) in elderly patients at surgical risk. There have been continuous technological advancements in the latest iterations of TAVI devices and implantation techniques, [...] Read more.
Over the past few years, transcatheter aortic valve implantation (TAVI) imposed itself as the first-choice therapy for symptomatic aortic stenosis (AS) in elderly patients at surgical risk. There have been continuous technological advancements in the latest iterations of TAVI devices and implantation techniques, which have bolstered their adoption. Moreover, the favorable outcomes coming out from clinical trials represent an indisputable point of strength for TAVI. As indications for transcatheter therapies now include a low surgical risk and younger individuals, new challenges are emerging. In this context, the matter of prosthesis durability is noteworthy. Initial evidence is beginning to emerge from the studies in the field, but they are still limited and compromised by multiple biases. Additionally, the physiopathological mechanisms behind the valve’s deterioration are nowadays somewhat clearer and classified. So, who outlasts who—the valve or the patient? This review aims to explore the available evidence surrounding this intriguing question, examining the various factors affecting prosthesis durability and discussing its potential implications for clinical management and current interventional practice. Full article
(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)
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12 pages, 2093 KiB  
Review
Transcatheter Aortic Valve Implantation for Severe Chronic Aortic Regurgitation
by Judy Al Ahmad and Edward Danson
J. Clin. Med. 2024, 13(10), 2997; https://doi.org/10.3390/jcm13102997 - 20 May 2024
Cited by 2 | Viewed by 2738
Abstract
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was [...] Read more.
Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was previously labelled as a relative contraindication. However, TAVI has been utilised for selected cases of pure or predominant AR. The primary limitations regarding the use of TAVI in AR are related to the absence of anatomical factors seen in patients with AS that have contributed to the safe and stable functioning of current-generation prostheses. These include aortic root dilatation, mobile valve leaflets and labile blood pressure within the aortic root, which may further increase the risk of valve migration and periprosthetic leak after deployment. Furthermore, patients with AR have more heterogeneous aortic root anatomies when compared to the population of patients with calcific or degenerative AS. This review article describes the current evidence for the off-label use of TAVI in pure AR and the various clinical syndromes associated with AR where there may be specific challenges in the application of TAVI. Full article
(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)
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