Open Issues in TAVI Part 2
Open Issues in TAVI Part 2
This article provides an overview on procedure-related issues and uncertainties in outcomes after transcatheter aortic valve implantation (TAVI). The different access sites and how to select them in an individual patient are discussed. Also, the occurrence and potential predictors of aortic regurgitation (AR) after TAVI are addressed. The different methods to quantify AR are reviewed, and it appears that accurate and reproducible quantification is suboptimal. Complications such as prosthesis-patient mismatch and conduction abnormalities (and need for permanent pacemaker) are discussed, as well as cerebrovascular events, which emphasize the development of optimal anti-coagulative strategies. Finally, recent registries have shown the adoption of TAVI in the real world, but longer follow-up studies are needed to evaluate the outcome (but also prosthesis durability). Additionally, future studies are briefly discussed, which will address the use of TAVI in pure AR and lower-risk patients.
The current article is the second part of a review on the open issues in transcatheter aortic valve implantation (TAVI). In the first part, areas of controversy in patient selection were addressed, while in this second part the focus is on procedural issues and outcomes. Procedure-related areas of uncertainty include the choice between different access sites, and also the quantification and prediction of aortic regurgitation (AR) after TAVI. The prevalence of patient–prosthesis mismatch (PPM) after TAVI and its impact on the outcome will be addressed, as well as specific complications after TAVI such as development of conduction abnormalities with subsequent need for permanent pacemaker therapy, and occurrence of cerebrovascular events (CVE). Moreover, the optimal anti-coagulative strategy after TAVI is currently unclear.
Recently, valve-in-valve procedures (TAVI in a failing bioprosthetic valve) have been introduced and preliminary data are promising. In addition, the potential role of large clinical registries to determine the position of TAVI in the current clinical practice is important. All these issues will be reviewed and the potential future indications (pure AR, low-risk populations) of TAVI will be discussed at the end of this article.
Abstract and Introduction
Abstract
This article provides an overview on procedure-related issues and uncertainties in outcomes after transcatheter aortic valve implantation (TAVI). The different access sites and how to select them in an individual patient are discussed. Also, the occurrence and potential predictors of aortic regurgitation (AR) after TAVI are addressed. The different methods to quantify AR are reviewed, and it appears that accurate and reproducible quantification is suboptimal. Complications such as prosthesis-patient mismatch and conduction abnormalities (and need for permanent pacemaker) are discussed, as well as cerebrovascular events, which emphasize the development of optimal anti-coagulative strategies. Finally, recent registries have shown the adoption of TAVI in the real world, but longer follow-up studies are needed to evaluate the outcome (but also prosthesis durability). Additionally, future studies are briefly discussed, which will address the use of TAVI in pure AR and lower-risk patients.
Introduction
The current article is the second part of a review on the open issues in transcatheter aortic valve implantation (TAVI). In the first part, areas of controversy in patient selection were addressed, while in this second part the focus is on procedural issues and outcomes. Procedure-related areas of uncertainty include the choice between different access sites, and also the quantification and prediction of aortic regurgitation (AR) after TAVI. The prevalence of patient–prosthesis mismatch (PPM) after TAVI and its impact on the outcome will be addressed, as well as specific complications after TAVI such as development of conduction abnormalities with subsequent need for permanent pacemaker therapy, and occurrence of cerebrovascular events (CVE). Moreover, the optimal anti-coagulative strategy after TAVI is currently unclear.
Recently, valve-in-valve procedures (TAVI in a failing bioprosthetic valve) have been introduced and preliminary data are promising. In addition, the potential role of large clinical registries to determine the position of TAVI in the current clinical practice is important. All these issues will be reviewed and the potential future indications (pure AR, low-risk populations) of TAVI will be discussed at the end of this article.
Source...