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Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects

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

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 9347

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Prof. Dr. Konstantinos Toutouzas

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Guest Editor

First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
Interests: structural heart disease; mitral and aortic valvuloplasty; transcatheter aortic valve implantations; intravascular imaging; percutaneous coronary interventions
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Special Issue Information

Dear Colleagues,

I am currently serving as Guest Editor for the Special Issue “Transcatheter Aortic Valve Implantation: Latest Advances and Future Prospects”, which will be published in Journal of Clinical Medicine. Transcatheter aortic valve implantation (TAVI) has gained ground in the two last decades, and its indications have been expanded to lower-risk and younger patients suffering from aortic valve stenosis. Newer prostheses and improved techniques have a positive impact on patients’ life expectancy and quality of life. The aim of this Special Issue is to present the recent advances and future directions of aortic stenosis management with TAVI.

Prof. Dr. Konstantinos Toutouzas
Guest Editor

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Keywords

TAVI
TAVR
aortic stenosis
transcatheter aortic valve implantation
structural heart disease

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Published Papers (4 papers)

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Research

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10 pages, 4475 KiB

Open AccessArticle

Quantification of Aortic Valve Calcification in Contrast-Enhanced Computed Tomography

by Danai Laohachewin, Philipp Ruile, Philipp Breitbart, Jan Minners, Nikolaus Jander, Martin Soschynski, Christopher L. Schlett, Franz-Josef Neumann, Dirk Westermann and Manuel Hein

J. Clin. Med. 2024, 13(8), 2386; https://doi.org/10.3390/jcm13082386 - 19 Apr 2024

Cited by 1 | Viewed by 1713

Abstract

Background: The goal of our study is to evaluate a method to quantify aortic valve calcification (AVC) in contrast-enhanced computed tomography for patients with suspected severe aortic stenosis pre-interventionally. Methods: A total of sixty-five patients with aortic stenosis underwent both a native and a contrast-enhanced computed tomography (CECT) scan of the aortic valve (45 in the training cohort and 20 in the validation cohort) using a standardized protocol. Aortic valve calcification was semi-automatically quantified via the Agatston score method for the native scans and was used as a reference. For contrast-enhanced computed tomography, a calcium threshold of the Hounsfield units of the aorta plus four times the standard deviation was used. Results: For the quantification of aortic valve calcification in contrast-enhanced computed tomography, a conversion formula (691 + 1.83 x AVCCECT) was derived via a linear regression model in the training cohort. The validation in the second cohort showed high agreement for this conversion formula with no significant proportional bias (Bland–Altman, p = 0.055) and with an intraclass correlation coefficient in the validation cohort of 0.915 (confidence interval 95% 0.786–0.966) p < 0.001. Conclusions: Calcium scoring in patients with aortic valve stenosis can be performed using contrast-enhanced computed tomography with high validity. Using a conversion factor led to an excellent agreement, thereby obviating an additional native computed tomography scan. This might contribute to a decrease in radiation exposure. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects)

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17 pages, 1812 KiB

Open AccessArticle

Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation

by George Oikonomou, Anastasios Apostolos, Maria Drakopoulou, Chryssavgi Simopoulou, Maria Karmpalioti, Pantelis Toskas, Konstantinos Stathogiannis, Maria Xanthopoulou, Nikolaos Ktenopoulos, George Latsios, Andreas Synetos, Constantinos Tsioufis and Konstantinos Toutouzas

J. Clin. Med. 2024, 13(5), 1200; https://doi.org/10.3390/jcm13051200 - 20 Feb 2024

Cited by 5 | Viewed by 1569

Abstract

Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow—low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m² and mean gradient (MG) < 40 mmHg); (ii) normal flow—low gradient (NF-LG): SVi > 35 mL/m² and MG < 40 mmHg; (iii) low flow—high gradient (LF-HG): Svi 35 mL/m² and MG ≥ 40 mmHg and (iv) normal flow—high gradient (NF-HG): SVi > 35 mL/m² and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918–0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645–5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106–1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects)

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Review

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20 pages, 1531 KiB

Open AccessReview

Myval Transcatheter Heart Valve: The Future of Transcatheter Valve Replacement and Significance in Current Timeline

by Teoman Kilic, Senol Coskun, Didar Mirzamidinov, Irem Yilmaz, Sadan Yavuz and Tayfun Sahin

J. Clin. Med. 2024, 13(22), 6857; https://doi.org/10.3390/jcm13226857 - 14 Nov 2024

Viewed by 2585

Abstract

The Myval is a balloon-expandable transcatheter heart valve (THV) developed by Meril Life Sciences Pvt. Ltd. (Vapi, Gujarat, India) that has an innovative operator-friendly design that aids in improving deliverability and features precise deployment. Various clinical studies demonstrate its effectiveness and safety, making it a promising choice in valvular interventions. Myval has been successfully utilized as a transcatheter aortic valve implantation (TAVI) device in cases with conduction disturbances, bicuspid aortic valve anatomy, non-calcified aortic regurgitation, dysfunctional stenosed right ventricular outflow tract (RVOT) conduits, pulmonary valve replacement, mitral valve replacement, and valve-in-valve and valve-in-ring implantation procedures. Myval’s diverse sizes are also of key importance in complex cases of large annuli and complex anatomy. Further long-term studies are needed to consolidate these results. Its introduction signifies a significant advancement in cardiology, aiming to enhance patient outcomes and quality of life. In the present review, we provide an update on new-generation Myval THV series and review the available clinical data published to date with an emphasis on diverse use in specific clinical scenarios. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects)

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14 pages, 1760 KiB

Open AccessReview

Impact of Stress Echocardiography on Aortic Valve Stenosis Management

by Andreas Synetos, Konstantina Vlasopoulou, Maria Drakopoulou, Anastasios Apostolos, Nikolaos Ktenopoulos, Odysseas Katsaros, Theofanis Korovesis, George Latsios and Kostas Tsioufis

J. Clin. Med. 2024, 13(12), 3495; https://doi.org/10.3390/jcm13123495 - 14 Jun 2024

Viewed by 2907

Abstract

Rest and stress echocardiography (SE) play a fundamental role in the evaluation of aortic valve stenosis (AS). According to the current guidelines for the echocardiographic evaluation of patients with aortic stenosis, four broad categories can be defined: high-gradient AS (mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s, aortic valve area (AVA) ≤ 1 cm² or indexed AVA ≤ 0.6 cm²/m²); low-flow, low-gradient AS with reduced ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm², left ventricle ejection fraction (LVEF) < 50%, stroke volume index (Svi) ≤ 35 mL/m²); low-flow, low-gradient AS with preserved ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm², LVEF ≥ 50%, SVi ≤ 35 mL/m²); and normal-flow, low-gradient AS with preserved ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm², indexed AVA ≤ 0.6 cm²/m², LVEF ≥ 50%, SVi > 35 mL/m²). Aortic valve replacement (AVR) is indicated with the onset of symptoms development or LVEF reduction. However, there is often mismatch between resting transthoracic echocardiography findings and patient’s symptoms. In these discordant cases, SE and CT calcium scoring are among the indicated methods to guide the management decision making. Additionally, due to the increasing evidence that in asymptomatic severe aortic stenosis an early AVR instead of conservative treatment is associated with better outcomes, SE can help identify those that would benefit from an early AVR by revealing markers of poor prognosis. Low-flow, low-gradient AS represents a challenge both in diagnosis and in therapeutic management. Low-dose dobutamine SE is the recommended method to distinguish true-severe from pseudo-severe stenosis and assess the existence of flow (contractile) reserve to appropriately guide the need for intervention in these patients. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation and Replacement: The Latest Advances and Prospects)

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