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Review
. 2021 Jul 14;57(7):711.
doi: 10.3390/medicina57070711.

Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

Niccolò Ciardetti  1 , Francesca Ciatti  1 , Giulia Nardi  1 , Francesca Maria Di Muro  1 , Pierluigi Demola  1 , Edoardo Sottili  1 , Miroslava Stolcova  1 , Francesca Ristalli  1 , Alessio Mattesini  1 , Francesco Meucci  1 , Carlo Di Mario  1
Affiliations
Review

Advancements in Transcatheter Aortic Valve Implantation: A Focused Update

Niccolò Ciardetti et al. Medicina (Kaunas). .

Abstract

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).

Keywords: TAVI; aortic valve replacement; cerebral protection devices; iliac intravascular lithotripsy; optimal valve positioning; transcatheter aortic valve implantation; valve-in-valve.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transcatheter aortic valve implantation (TAVI) virtuous cycle generated by increased operators’ experience and improved technology.
Figure 2
Figure 2
Intravascular lithotripsy (IVL) to facilitate TAVI (transcatheter aortic valve implantation) transfemoral access in a 79-years-old patient with severe aortic stenosis and end-stage chronic kidney disease on haemodialysis, arterial hypertension and diffuse peripheral arterial disease with claudication, previous renal artery stenting and severe carotid artery atherosclerosis. STS score: 7.5. Upper panels (A–D): severe occlusive calcific peripheral disease assessed by baseline aorto-iliac angiography (A); lesion preparation with IVL 6 × 60 mm Shockwave balloon on left common iliac artery inflated at 6 Atm with dog boning effect due to the severe calcification, 300 pulses delivered (B,C); intermediate result with greater lumen gain (D); lower panels (E–H): attempt to deliver a 14F sheath followed by further Shockwave 7 × 60 mm balloon inflation at 6 Atm (300 pulses) (E,F); the successful crossing of valve delivery system and final angiographic result showing absence of vessel rupture, dissection or perforation (G,H).
Figure 3
Figure 3
TriGuard™ cerebral protection device used in a patient with a bicuspid aortic valve during transcatheter aortic valve implantation (TAVI) (A) and the debris captured (B).
Figure 4
Figure 4
The impact of membranous septum (MS) length on permanent pacemaker implantation.
Figure 5
Figure 5
Optimizing fluoroscopic projections for transcatheter aortic valve implantation (TAVI). Panel (A) shows the basal aortography of the optimal projection for self-expandable valve implantation (“3 cusp view”), the nadirs of the three cusps (yellow = non-coronary [NCC], green = right-coronary [RCC], red = left-coronary [LCC]) are perfectly coplanar and equally spaced. Panel (B) shows an aortography of a cusp-overlap view obtained by overlapping the right-coronary cusp and the left-coronary cusp, isolating the non-coronary cusp and allowing to minimize interaction with the conduction system.
Figure 6
Figure 6
Post-implantation valve-in-valve view of a Corevalve Evolute R 26 mm inside a degenerated Sorin Mitroflow 23 mm.
See this image and copyright information in PMC

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