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Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives
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Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives

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 2023) | Viewed by 13767

Special Issue Editor

Dr. Jinhui Tian

E-Mail Website
Guest Editor
1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
2. Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
Interests: network meta-analysis; health technology assessment; evidence-based cardiovascular medicine

Special Issue Information

Dear Colleagues,

Transcatheter aortic valve Replacement (TAVR) has recently become the gold standard treatment for elderly patients affected by severe aortic stenosis regardless individual risk profile.

Although evidence from the latest randomized clinical trials has shown that TAVR is comparable or even superior to surgical aortic valve replacement, its adoption for younger patients is currently restricted to those at increased surgical risk due to the limited data available at long-term.

Latest iterations of TAVR devices have introduced different improvements with the aim to improve valve performances and facilitate valve deployment, whereas insights from CT assessment during TAVR workup and at follow-up have been highlighting the importance of a careful, patient-tailored procedure planning for ensuring optimal acute results and reducing potential issues that might have an impact in the long term.

Indeed, current TAVR practice is aiming at tailoring the best device for each patient, taking advantage of the specific characteristics of transcatheter aortic valves and anticipating the potential issues of the new aortic root environment after TAVR.

This Special Issue of the Journal of Clinical Medicine aims to attract original research articles, reviews, and short communications on the latest evidence in TAVR practice, with a particular look at device performances, coronary re-access, bicuspid aortic valves and long-term outcomes.

Dr. Jinhui Tian
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

  •  TAVR
  •  bicuspid valve
  •  long-term
  •  TAV performance
  •  Indications
  •  outcomes
  •  CT
  •  coronary re-access
  •  patient-tailored

Published Papers (6 papers)

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Research

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10 pages, 1043 KiB  
Article
Combining Minimally Invasive Direct Coronary Artery Bypass Grafting with Transapical Aortic Valve Implantation—The Next Level Heart Team Approach
by Jules Miazza, Ion Vasiloi, Luca Koechlin, Brigitta Gahl, David Santer, Denis Berdajs, Thomas Nestelberger, Christoph Kaiser, Friedrich Eckstein and Oliver Reuthebuch
J. Clin. Med. 2023, 12(21), 6890; https://doi.org/10.3390/jcm12216890 - 1 Nov 2023
Viewed by 762
Abstract
We present the results of a combined approach for transapical aortic valve replacement and minimally invasive coronary artery bypass grafting (taTAVI-MIDCAB) in patients with combined aortic stenosis and coronary artery disease. Background: For patients presenting with aortic stenosis and coronary artery disease, a [...] Read more.
We present the results of a combined approach for transapical aortic valve replacement and minimally invasive coronary artery bypass grafting (taTAVI-MIDCAB) in patients with combined aortic stenosis and coronary artery disease. Background: For patients presenting with aortic stenosis and coronary artery disease, a simultaneous procedure addressing both diseases is recommended to reduce operative risk. In high-risk patients with hostile femoral or coronary axis, taTAVI-MIDCAB can be an alternative minimally invasive approach, offering the benefits of left interior mammary artery to left anterior descending coronary artery (LIMA-LAD) grafting. Methods: From 2014 to 2022, 10 patients underwent taTAVI-MIDCAB for combined coronary and severe aortic stenosis in the hybrid operation theater at our institution. We assessed perioperative outcomes and follow-up outcomes. Results: The median age was 83 years (81 to 86). The procedure was successfully performed in all patients without conversion to sternotomy. The median length of hospital and intensive care unit stay was 9 days (7 to 16) and 2.5 days (1 to 5), respectively. The median flow over the coronary artery bypass was 31 (22 to 44) mL/min, with a pulsatility index (PI) of 2.4 (2.1 to 3.2). Mild paravalvular leak occurred in 2 patients (10%). There were no neurological events nor acute kidney injury. Pacemaker implantation was required in 1 patient (10%). Conclusions: Simultaneous surgical coronary revascularization and interventional valve implantation in the setting of a hostile femoral and coronary axis appears to be safe and beneficial. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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12 pages, 2507 KiB  
Article
One-Year Outcomes and Trends over Two Eras of Transcatheter Aortic Valve Implantation in Real-World Practice
by Giuliano Costa, Paola D’Errigo, Stefano Rosato, Fausto Biancari, Andrea Marcellusi, Giuseppe Tarantini, Gennaro Santoro, Massimo Baiocchi, Diego Maffeo, Claudia Fiorina, Francesco Cerza, Giovanni Baglio, Tatu Juvonen, Gabriella Badoni, Roberto Valvo, Fulvia Seccareccia, Marco Barbanti, Corrado Tamburino and on behalf of the OBSERVANT II Research Group
J. Clin. Med. 2022, 11(5), 1164; https://doi.org/10.3390/jcm11051164 - 22 Feb 2022
Cited by 3 | Viewed by 1647
Abstract
Background: Data reflecting the benefit of procedural improvements in real-world transcatheter aortic valve implantation (TAVI) practice are sparse. Aims: To compare outcomes and trends of two TAVI eras from real Italian practice. Methods: A total of 1811 and 2939 TAVI patients enrolled in [...] Read more.
Background: Data reflecting the benefit of procedural improvements in real-world transcatheter aortic valve implantation (TAVI) practice are sparse. Aims: To compare outcomes and trends of two TAVI eras from real Italian practice. Methods: A total of 1811 and 2939 TAVI patients enrolled in the national, prospective OBSERVANT and OBSERVANT II studies in 2010–2012 and 2016–2018, respectively, were compared in a cohort study. Outcomes were adjusted using inverse propensity of treatment weighting and propensity score matching. Results: The median age (83.0 (79.0–86.0) vs. 83.0 (79.0–86.0)) and EuroSCORE II (5.2 (3.2–7.7) vs. 5.1 (3.1–8.1)) of OBSERVANT and OBSERVANT II patients were similar. At 1 year, patients of the OBSERVANT II study had a significantly lower risk of all-cause death (10.6% vs. 16.3%, Hazard Ratio (HR) 0.63 (95% Confidence Interval (CI) 0.52–0.76)) and rehospitalization for heart failure (HF) (14.3% vs. 19.5%, Sub-distribution HR 0.71 (95%CI 0.60–0.84)), whereas rates of stroke (3.1% vs. 3.6%) and permanent pacemaker implantation (PPI) (16.6% vs. 18.0%) were comparable between study groups. Conclusions: Age and risk profile among patients undergoing TAVI in Italy remained substantially unchanged between the 2010–2012 and 2016–2018 time periods. After adjustment, patients undergoing TAVI in the most recent era had lower risk of all-cause death and rehospitalization for HF at 1 year, whereas rates of stroke and PPI did not differ significantly. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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Review

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25 pages, 2484 KiB  
Review
Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes
by Anas M. Tahir, Onur Mutlu, Faycal Bensaali, Rabab Ward, Abdel Naser Ghareeb, Sherif M. H. A. Helmy, Khaled T. Othman, Mohammed A. Al-Hashemi, Salem Abujalala, Muhammad E. H. Chowdhury, A.Rahman D. M. H. Alnabti and Huseyin C. Yalcin
J. Clin. Med. 2023, 12(14), 4774; https://doi.org/10.3390/jcm12144774 - 19 Jul 2023
Cited by 2 | Viewed by 1607
Abstract
Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR [...] Read more.
Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR outcome. Assessment of computational fluid dynamics (CFD), finite element analysis (FEA), and fluid–solid interaction (FSI) analysis offer a solution that has been increasingly utilized to evaluate BHV mechanics and dynamics. However, the high computational costs and the complex operation of computational modeling hinder its application. Recent advancements in the deep learning (DL) domain can offer a real-time surrogate that can render hemodynamic parameters in a few seconds, thus guiding clinicians to select the optimal treatment option. Herein, we provide a comprehensive review of classical computational modeling approaches, medical imaging, and DL approaches for planning and outcome assessment of TAVR. Particularly, we focus on DL approaches in previous studies, highlighting the utilized datasets, deployed DL models, and achieved results. We emphasize the critical challenges and recommend several future directions for innovative researchers to tackle. Finally, an end-to-end smart DL framework is outlined for real-time assessment and recommendation of the best BHV design for TAVR. Ultimately, deploying such a framework in future studies will support clinicians in minimizing risks during TAVR therapy planning and will help in improving patient care. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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12 pages, 4116 KiB  
Review
Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement
by Angelo Quagliana, Nicholas J. Montarello, Yannick Willemen, Pernille S. Bække, Troels H. Jørgensen, Ole De Backer and Lars Sondergaard
J. Clin. Med. 2023, 12(6), 2136; https://doi.org/10.3390/jcm12062136 - 9 Mar 2023
Cited by 3 | Viewed by 3308
Abstract
Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves [...] Read more.
Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves facilitates coronary access after TAVR and is thus considered a procedural goal, allowing long-term management of coronary artery disease. Moreover, commissural alignment may potentially have a positive impact on transvalvular hemodynamic and valve durability. This review focus on technical hints to achieve commissural alignment and current evidence for different transcatheter aortic valves. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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23 pages, 1978 KiB  
Review
Prosthesis Tailoring for Patients Undergoing Transcatheter Aortic Valve Implantation
by Pier Pasquale Leone, Andrea Scotti, Edwin C. Ho, Manaf Assafin, James Doolittle, Mei Chau, Leandro Slipczuk, Matthew Levitus, Damiano Regazzoli, Antonio Mangieri and Azeem Latib
J. Clin. Med. 2023, 12(1), 338; https://doi.org/10.3390/jcm12010338 - 1 Jan 2023
Cited by 7 | Viewed by 4616
Abstract
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of [...] Read more.
Transcatheter aortic valve implantation (TAVI) has risen over the past 20 years as a safe and effective alternative to surgical aortic valve replacement for treatment of severe aortic stenosis, and is now a well-established and recommended treatment option in suitable patients irrespective of predicted risk of mortality after surgery. Studies of numerous devices, either newly developed or reiterations of previous prostheses, have been accruing. We hereby review TAVI devices, with a focus on commercially available options, and aim to present a guide for prosthesis tailoring according to patient-related anatomical and clinical factors that may favor particular designs. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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Other

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7 pages, 1749 KiB  
Case Report
Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement
by Jan Naar, Dagmar Vondrakova, Andreas Kruger, Marek Janotka, Iva Zemanova, Martin Syrucek, Petr Neuzil and Petr Ostadal
J. Clin. Med. 2023, 12(16), 5318; https://doi.org/10.3390/jcm12165318 - 16 Aug 2023
Viewed by 809
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented [...] Read more.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented in self-expanding, as well as balloon-expandable TAVR valves, manifested primarily as acute aortic syndrome. We present the case of a 76-year-old male, who experienced refractory in-hospital cardiac arrest with non-shockable rhythm due to the obstruction of coronary flow caused by aortic dissection type A, with entry directly adjacent to the aortic prosthesis according to autopsy. The patient died despite the engagement of extracorporeal cardiopulmonary resuscitation. Aortic dissection developed one year after a transfemoral TAVR procedure using an Edwards SAPIEN 3 29 mm self-expanding valve. TAVR-associated late aortic dissection type A represents a rare, life-threatening condition with various clinical manifestations. The risk factors have not been well described and the differential diagnosis may be challenging. As the number of TAVR recipients and their life expectancy is increasing, we may face this complication more often in future. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Current Status and Future Perspectives)
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