Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

• Published in: Medicina (Kaunas, Lithuania) Vol. 57; no. 7; p. 711
• Main Authors: Ciardetti, Niccolò, Ciatti, Francesca, Nardi, Giulia, Di Muro, Francesca Maria, Demola, Pierluigi, Sottili, Edoardo, Stolcova, Miroslava, Ristalli, Francesca, Mattesini, Alessio, Meucci, Francesco, Di Mario, Carlo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 14-07-2021; MDPI
• Subjects: Aortic Valve - surgery; Aortic Valve Insufficiency; aortic valve replacement; Aortic Valve Stenosis - surgery; Calcification; Cardiovascular disease; cerebral protection devices; Heart; Heart Valve Prosthesis; Humans; iliac intravascular lithotripsy; Life expectancy; Lithotripsy; Local anesthesia; Mortality; optimal valve positioning; Pacemakers; Patients; Prostheses; Review; Risk Factors; Stroke; TAVI; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement; Treatment Outcome; United States > US; transcatheter aortic valve implantation; aortic valve replacement; TAVI; cerebral protection devices; valve-in-valve; iliac intravascular lithotripsy; optimal valve positioning
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina57070711

Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).