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Review
. 2022 Jul 12;9(7):223.
doi: 10.3390/jcdd9070223.

TAVR for All? The Surgical Perspective

Xiling Zhang  1   2 , Thomas Puehler  1   2 , Derk Frank  3 , Janarthanan Sathananthan  4   5   6   7 , Stephanie Sellers  4   5   6   7 , David Meier  4   5   6 , Marcus Both  8 , Philipp Blanke  9 , Hatim Seoudy  3 , Mohammed Saad  3 , Oliver J Müller  3 , Lars Sondergaard  10 , Georg Lutter  1   2
Affiliations
Review

TAVR for All? The Surgical Perspective

Xiling Zhang et al. J Cardiovasc Dev Dis. .

Abstract

In spite of the noninferiority of transcatheter aortic valve replacement (TAVR) in high- and intermediate-risk patients, there are still obstacles that need to be overcome before the procedure is further expanded and clinically integrated. The lack of evidence on the long-term durability of the bioprostheses used for TAVR remains of particular concern. In addition, surgery may be preferred over TAVR in patients with bicuspid aortic valve (BAV) or with concomitant pathologies such as other valve diseases (mitral regurgitation/tricuspid regurgitation), aortopathy, and coronary artery disease. In this review, we discuss and summarize relevant data from clinical trials, current trends, and remaining obstacles, and provide our perspective on the indications for the expansion of TAVR.

Keywords: aortic valve stenosis; high risk; intermediate risk; low risk; surgical aortic valve replacement (SAVR); transcatheter aortic valve implantation (TAVI); transcatheter aortic valve replacement (TAVR).

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Conflict of interest statement

Outside the submitted work the authors have the following commercial entities: T.P. is a consultant for Abbott. G.L. is a consultant for Edwards Lifesciences, Medtronic, and Abbott. D.F. is a consultant for Edwards Lifesciences and Medtronic and has received research funding from Edwards Lifesciences. M.S. is a consultant for Medtronic. J.S. is a Consultant for Edwards Lifesciences, Boston Scientific and Medtronic and received speaker fees from Edwards. S.S. is a consultant for Edwards Lifesciences and Medtronic. D.M. is supported by the Swiss National Science Foundation (grant P2LAP3_199561), L.S. has recieved consultant fees and/or institutional research grants from Abbott, Boston Scientific, Medtronic and SMT. P.B. is a consultant to Edwards Lifesciences, Abbott, Neovasc, and Circle Cardiovascular Imaging. All other authors have no conflict of interest.

Figures

Figure 1
Figure 1
(A–C) The SAPIEN XT, SAPIEN 3 and SAPIEN 3 Ultra. Image courtesy of Edwards Lifesciences; (D,E) the Evolut R and Evolut R pro. Image courtesy of Medtronic; (F,G) the ACURATE neo and ACURATE neo2. Image courtesy of Boston Scientific; (H) the ALLEGRA. Image courtesy of NEW VALVE TECHNOLOGY; (I) the Hydra. Image courtesy of SMT; (J) the Navitor device, Image courtesy of Abbott; (K) the Jena valve, Image courtesy of JenaValve Technology.
Figure 1
Figure 1
(A–C) The SAPIEN XT, SAPIEN 3 and SAPIEN 3 Ultra. Image courtesy of Edwards Lifesciences; (D,E) the Evolut R and Evolut R pro. Image courtesy of Medtronic; (F,G) the ACURATE neo and ACURATE neo2. Image courtesy of Boston Scientific; (H) the ALLEGRA. Image courtesy of NEW VALVE TECHNOLOGY; (I) the Hydra. Image courtesy of SMT; (J) the Navitor device, Image courtesy of Abbott; (K) the Jena valve, Image courtesy of JenaValve Technology.
Figure 2
Figure 2
Studies on TAVR versus SAVR in patients at different surgical risks and of similar age. The progressive decrease in age and STS scores of patients implanted with TAVI.STS: Society of Thoracic Surgeons.
Figure 3
Figure 3
The Sievers classification for a BAV. The black line in schematic drawings represents a raphe, which is the nonseparated or conjoint segment of two underdeveloped cusps extending into the commissural area [35].
Figure 4
Figure 4
Patient-, prosthesis- and procedure-related factors involved in degeneration of bioprosthetic valves in stents.
See this image and copyright information in PMC

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