Advertisement

Transcatheter aortic valve implantation: Update in 2018

  • Nils Perrin
    Affiliations
    Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland
    Search for articles by this author
  • Angela Frei
    Affiliations
    Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland
    Search for articles by this author
  • Stephane Noble
    Correspondence
    Corresponding author at: Structural Cardiology Unit, Division of Cardiology, Department of the Medical Specialties, University Hospital of Geneva, 4, Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
    Affiliations
    Structural Cardiology Unit, Division of Cardiology, Department of Medical Specialties at the University Hospital of Geneva, Switzerland
    Search for articles by this author

      Highlights

      • TAVI is nowadays feasible and safe in selected intermediate-risk patients.
      • High rates of conduction disorders and need for pacemaker remain major pitfalls.
      • TAVI device durability seems similar to surgical valves.
      • Asymptomatic severe aortic stenosis or symptomatic moderate stenosis are emerging indications.

      Abstract

      During the last 15 years, transcatheter aortic valve implantation (TAVI) has gained wide acceptance with good reproducible clinical and safety outcomes. Today, TAVI has not only overtaken conventional surgery as the standard of care for the treatment of patients with symptomatic aortic stenosis at high surgical risk, but can also be considered in selected intermediate-risk patients. This follows technological improvements, better patient assessment and increased operator experience leading to a significant reduction in most procedure-related complications and long-term mortality. In this review, we provide internists, on the one hand with current data in the TAVI field including clinical outcomes from the most recent, major trials and on the other hand, highlight the remaining pitfalls of this treatment and the gaps in evidence that need to be addressed in order to further improve clinical practice and expand its indication.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vahl T.P.
        • Kodali S.K.
        • Leon M.B.
        Transcatheter aortic valve replacement 2016: A modern-day "Through the Looking-Glass" Adventure.
        J Am Coll Cardiol. 2016; 67: 1472-1487
        • Kappetein A.P.
        • Head S.J.
        • Genereux P.
        • Piazza N.
        • van Mieghem N.M.
        • Blackstone E.H.
        • et al.
        Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research Consortium-2 consensus document.
        J Am Coll Cardiol. 2012; 60: 1438-1454
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • Antunes M.J.
        • Baron-Esquivias G.
        • Baumgartner H.
        • et al.
        Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2012; 33: 2451-2496
        • Omran H.
        • Schmidt H.
        • Hackenbroch M.
        • Illien S.
        • Bernhardt P.
        • von der Recke G.
        • et al.
        Silent and apparent cerebral embolism after retrograde catheterisation of the aortic valve in valvular stenosis: a prospective, randomised study.
        The Lancet. 2003; 361: 1241-1246
        • Clavel M.A.
        • Pibarot P.
        • Messika-Zeitoun D.
        • Capoulade R.
        • Malouf J.
        • Aggarval S.
        • et al.
        Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study.
        J Am Coll Cardiol. 2014; 64: 1202-1213
        • Dumesnil J.G.
        • Pibarot P.
        • Carabello B.
        Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment.
        Eur Heart J. 2010; 31: 281-289
        • Leon M.B.
        • Smith C.R.
        • Mack M.J.
        • Makkar R.R.
        • Svensson L.G.
        • Kodali S.K.
        • et al.
        Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2016; 374: 1609-1620
        • Edwards F.H.
        • Cohen D.J.
        • O'Brien S.M.
        • Peterson E.D.
        • Mack M.J.
        • Shahian D.M.
        • et al.
        Development and validation of a risk prediction model for in-hospital mortality after Transcatheter aortic valve replacement.
        JAMA Cardiol. 2016; 1: 46-52
        • Pilgrim T.
        • Franzone A.
        • Stortecky S.
        • Nietlispach F.
        • Haynes A.G.
        • Tueller D.
        • et al.
        Predicting mortality after Transcatheter aortic valve replacement: external validation of the Transcatheter valve therapy registry model.
        Circ Cardiovasc Interv. 2017; 10
        • Schoenenberger A.W.
        • Stortecky S.
        • Neumann S.
        • Moser A.
        • Juni P.
        • Carrel T.
        • et al.
        Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI).
        Eur Heart J. 2013; 34: 684-692
        • Cribier A.
        • Eltchaninoff H.
        • Bash A.
        • Borenstein N.
        • Tron C.
        • Bauer F.
        • et al.
        Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description.
        Circulation. 2002; 106: 3006-3008
        • Kodali S.
        • Thourani V.H.
        • White J.
        • Malaisrie S.C.
        • Lim S.
        • Greason K.L.
        • et al.
        Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis.
        Eur Heart J. 2016; 37: 2252-2262
        • Sorajja P.
        • Kodali S.
        • Reardon M.J.
        • Szeto W.Y.
        • Chetcuti S.J.
        • Hermiller Jr., J.
        • et al.
        Outcomes for the commercial use of self-expanding prostheses in Transcatheter aortic valve replacement: A Report From the STS/ACC TVT Registry.
        JACC Cardiovasc Interv. 2017; 10: 2090-2098
        • Baumgartner H.
        • Falk V.
        • Bax J.J.
        • De Bonis M.
        • Hamm C.
        • Holm P.J.
        • et al.
        ESC/EACTS guidelines for the management of valvular heart disease.
        Eur Heart J. 2017; 38: 2739-2791
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Fleisher L.A.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
        J Am Coll Cardiol. 2017; 70: 252-289
        • Reardon M.J.
        • Van Mieghem N.M.
        • Popma J.J.
        • Kleiman N.S.
        • Sondergaard L.
        • Mumtaz M.
        • et al.
        Surgical or Transcatheter aortic-valve replacement in intermediate-risk patients.
        N Engl J Med. 2017; 376: 1321-1331
        • Serruys P.W.
        Clinical outcomes of Surgical or transcatheter aortic valve replacement in intermediate risk patients Stratified by STS score: Results from the SURTAVI trial.
        in: Presented at the transcatheter cardiovascular therapeutics (TCT) meeting 2017, Denver. 2017
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • et al.
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Mack M.J.
        • Leon M.B.
        • Smith C.R.
        • Miller D.C.
        • Moses J.W.
        • Tuzcu E.M.
        • et al.
        5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385: 2477-2484
        • Adams D.H.
        • Popma J.J.
        • Reardon M.J.
        Transcatheter aortic-valve replacement with a self-expanding prosthesis.
        N Engl J Med. 2014; 371: 967-968
        • Kahlert P.
        • Knipp S.C.
        • Schlamann M.
        • Thielmann M.
        • Al-Rashid F.
        • Weber M.
        • et al.
        Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study.
        Circulation. 2010; 121: 870-878
        • Bagur R.
        • Solo K.
        • Alghofaili S.
        • Nombela-Franco L.
        • Kwok C.S.
        • Hayman S.
        • et al.
        Cerebral embolic protection devices during Transcatheter aortic valve implantation: systematic review and meta-analysis.
        Stroke. 2017; 48: 1306-1315
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • et al.
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Takagi H.
        • Umemoto T.
        • A. Group
        Impact of paravalvular aortic regurgitation after transcatheter aortic valve implantation on survival.
        Int J Cardiol. 2016; 221: 46-51
        • Blackman D.J.
        • Meredith I.T.
        • Dumonteil N.
        • Tchetche D.
        • Hildick-Smith D.
        • Spence M.S.
        • et al.
        Predictors of paravalvular regurgitation after implantation of the fully repositionable and retrievable Lotus Transcatheter aortic valve (from the REPRISE II trial extended cohort).
        Am J Cardiol. 2017; 120: 292-299
        • Yang T.H.
        • Webb J.G.
        • Blanke P.
        • Dvir D.
        • Hansson N.C.
        • Norgaard B.L.
        • et al.
        Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the Sapien 3: a comparison with the Sapien XT.
        JACC Cardiovasc Interv. 2015; 8: 462-471
        • Hahn R.T.
        • Pibarot P.
        • Webb J.
        • Rodes-Cabau J.
        • Herrmann H.C.
        • Williams M.
        • et al.
        Outcomes with post-dilation following transcatheter aortic valve replacement: the PARTNER I trial (placement of aortic transcatheter valve).
        JACC Cardiovasc Interv. 2014; 7: 781-789
        • Nombela-Franco L.
        • Rodes-Cabau J.
        • DeLarochelliere R.
        • Larose E.
        • Doyle D.
        • Villeneuve J.
        • et al.
        Predictive factors, efficacy, and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloon-expandable valve.
        JACC Cardiovasc Interv. 2012; 5: 499-512
        • Clerfond G.
        • Pereira B.
        • Innorta A.
        • Motreff P.
        • Gilard M.
        • Laskar M.
        • et al.
        Comparison of outcomes after one-versus-two transcatheter aortic valve implantation during a same procedure (from the FRANCE2 registry).
        Am J Cardiol. 2015; 115: 1273-1280
        • Calvert P.A.
        • Northridge D.B.
        • Malik I.S.
        • Shapiro L.
        • Ludman P.
        • Qureshi S.A.
        • et al.
        Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland.
        Circulation. 2016; 134: 934-944
        • Millan X.
        • Skaf S.
        • Joseph L.
        • Ruiz C.
        • Garcia E.
        • Smolka G.
        • et al.
        Transcatheter reduction of paravalvular leaks: a systematic review and meta-analysis.
        Can J Cardiol. 2015; 31: 260-269
        • Noble S.
        • Jolicoeur E.M.
        • Basmadjian A.
        • Levesque S.
        • Nozza A.
        • Potvin J.
        • et al.
        Percutaneous paravalvular leak reduction: procedural and long-term clinical outcomes.
        Can J Cardiol. 2013; 29: 1422-1428
        • Rossi M.L.
        • Belli G.
        • Pagnotta P.
        • Lucarelli C.
        • Presbitero P.
        Paravalvular leak leading to severe aortic valve regurgitation after TAVI: percutaneous closure strategy.
        Heart Lung Circ. 2015; 24: 936-939
        • Bax J.J.
        • Delgado V.
        • Bapat V.
        • Baumgartner H.
        • Collet J.P.
        • Erbel R.
        • et al.
        Open issues in transcatheter aortic valve implantation. Part 2: procedural issues and outcomes after transcatheter aortic valve implantation.
        Eur Heart J. 2014; 35: 2639-2654
        • Auffret V.
        • Puri R.
        • Urena M.
        • Chamandi C.
        • Rodriguez-Gabella T.
        • Philippon F.
        • et al.
        Conduction disturbances after Transcatheter aortic valve replacement: current status and future perspectives.
        Circulation. 2017; 136: 1049-1069
        • Piazza N.
        • Onuma Y.
        • Jesserun E.
        • Kint P.P.
        • Maugenest A.M.
        • Anderson R.H.
        • et al.
        Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve.
        JACC Cardiovasc Interv. 2008; 1: 310-316
        • Houthuizen P.
        • Van Garsse L.A.
        • Poels T.T.
        • de Jaegere P.
        • van der Boon R.M.
        • Swinkels B.M.
        • et al.
        Left bundle-branch block induced by transcatheter aortic valve implantation increases risk of death.
        Circulation. 2012; 126: 720-728
        • Nazif T.M.
        • Williams M.R.
        • Hahn R.T.
        • Kapadia S.
        • Babaliaros V.
        • Rodes-Cabau J.
        • et al.
        Clinical implications of new-onset left bundle branch block after transcatheter aortic valve replacement: analysis of the PARTNER experience.
        Eur Heart J. 2014; 35: 1599-1607
        • Urena M.
        • Webb J.G.
        • Cheema A.
        • Serra V.
        • Toggweiler S.
        • Barbanti M.
        • et al.
        Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve.
        JACC Cardiovasc Interv. 2014; 7: 128-136
        • Fadahunsi O.O.
        • Olowoyeye A.
        • Ukaigwe A.
        • Li Z.
        • Vora A.N.
        • Vemulapalli S.
        • et al.
        Incidence, predictors, and outcomes of permanent pacemaker implantation following Transcatheter aortic valve replacement: Analysis From the US Society of Thoracic Surgeons/American College of Cardiology TVT Registry.
        JACC Cardiovasc Interv. 2016; 9: 2189-2199
        • Genereux P.
        • Webb J.G.
        • Svensson L.G.
        • Kodali S.K.
        • Satler L.F.
        • Fearon W.F.
        • et al.
        Vascular complications after transcatheter aortic valve replacement: insights from the PARTNER (Placement of AoRTic TraNscathetER Valve) trial.
        J Am Coll Cardiol. 2012; 60: 1043-1052
        • Perrin N.
        • Ellenberger C.
        • Licker M.
        • Hachulla A.L.
        • Cikirikcioglu M.
        • Frei A.
        • et al.
        Management of vascular complications following transcatheter aortic valve implantation.
        Arch Cardiovasc Dis. 2015; 108: 491-501
        • Stortecky S.
        • Wenaweser P.
        • Diehm N.
        • Pilgrim T.
        • Huber C.
        • Rosskopf A.B.
        • et al.
        Percutaneous management of vascular complications in patients undergoing transcatheter aortic valve implantation.
        JACC Cardiovasc Interv. 2012; 5: 515-524
        • Dvir D.
        • Webb J.G.
        • Bleiziffer S.
        • Pasic M.
        • Waksman R.
        • Kodali S.
        • et al.
        Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.
        JAMA. 2014; 312: 162-170
        • Schussler O.
        • Shen M.
        • Shen L.
        • Carpentier S.M.
        • Kaveri S.
        • Carpentier A.
        Effect of human immunoglobulins on the immunogenicity of porcine bioprostheses.
        Ann Thorac Surg. 2001; 71: S396-S400
        • Leetmaa T.
        • Hansson N.C.
        • Leipsic J.
        • Jensen K.
        • Poulsen S.H.
        • Andersen H.R.
        • et al.
        Early aortic transcatheter heart valve thrombosis: diagnostic value of contrast-enhanced multidetector computed tomography.
        Circ Cardiovasc Interv. 2015; 8
        • Chakravarty T.
        • Sondergaard L.
        • Friedman J.
        • De Backer O.
        • Berman D.
        • Kofoed K.F.
        • et al.
        Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study.
        Lancet. 2017; 389: 2383-2392
        • Noble S.
        • Asgar A.
        • Cartier R.
        • Virmani R.
        • Bonan R.
        Anatomo-pathological analysis after CoreValve Revalving system implantation.
        EuroIntervention. 2009; 5: 78-85
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Fleisher L.A.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the Management of Patients with Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        Circulation. 2017; 135: e1159-e1195
        • Capodanno D.
        • Angiolillo D.J.
        Antithrombotic therapy for prevention of cerebral thromboembolic events after transcatheter aortic valve replacement: Evolving paradigms and ongoing directions.
        JACC Cardiovasc Interv. 2017; 10: 1366-1369
        • Depta J.P.
        • Bhatt D.L.
        New approaches to inhibiting platelets and coagulation.
        Annu Rev Pharmacol Toxicol. 2015; 55: 373-397
        • Ruile P.
        • Jander N.
        • Blanke P.
        • Schoechlin S.
        • Reinohl J.
        • Gick M.
        • et al.
        Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation.
        Clin Res Cardiol. 2017; 106: 85-95
        • Pellikka P.A.
        • Sarano M.E.
        • Nishimura R.A.
        • Malouf J.F.
        • Bailey K.R.
        • Scott C.G.
        • et al.
        Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up.
        Circulation. 2005; 111: 3290-3295
        • Genereux P.
        • Stone G.W.
        • O'Gara P.T.
        • Marquis-Gravel G.
        • Redfors B.
        • Giustino G.
        • et al.
        Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis.
        J Am Coll Cardiol. 2016; 67: 2263-2288
        • Genereux P.
        • Pibarot P.
        • Redfors B.
        • Mack M.J.
        • Makkar R.R.
        • Jaber W.A.
        • et al.
        Staging classification of aortic stenosis based on the extent of cardiac damage.
        Eur Heart J. 2017; 38: 3351-3358https://doi.org/10.1093/eurheart/ehx381
        • van Gils L.
        • Clavel M.A.
        • Vollema E.M.
        • Hahn R.T.
        • Spitzer E.
        • Delgado V.
        • et al.
        Prognostic implications of moderate aortic stenosis in patients with left ventricular systolic dysfunction.
        J Am Coll Cardiol. 2017; 69: 2383-2392
        • Samad Z.
        • Vora A.N.
        • Dunning A.
        • Schulte P.J.
        • Shaw L.K.
        • Al-Enezi F.
        • et al.
        Aortic valve surgery and survival in patients with moderate or severe aortic stenosis and left ventricular dysfunction.
        Eur Heart J. 2016; 37: 2276-2286
        • Perrin N.
        • N. S.
        Insight from a large real-world cohort of patients: does it confirm the results of the randomized trials?.
        in: Ann Transl Med. 2017
        • Kapadia S.R.
        • Leon M.B.
        • Makkar R.R.
        • Tuzcu E.M.
        • Svensson L.G.
        • Kodali S.
        • et al.
        5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385: 2485-2491
        • Eltchaninoff H.
        Late (>5 years) clinical and Echo outcomes after TAVR: The Rouen experience.
        in: Prestented at EuroPCR 2016, Paris. 2016
        • Barbanti M.
        • Petronio A.S.
        • Ettori F.
        • Latib A.
        • Bedogni F.
        • De Marco F.
        • et al.
        5-year outcomes after Transcatheter aortic valve implantation with CoreValve prosthesis.
        JACC Cardiovasc Interv. 2015; 8: 1084-1091