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Review
. 2022 Nov 21;9(11):407.
doi: 10.3390/jcdd9110407.

Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach

Andreas Mitsis  1 , Xun Yuan  2   3 , Christos Eftychiou  1 , Panayiotis Avraamides  1 , Christoph A Nienaber  2   3
Affiliations
Review

Personalised Treatment in Aortic Stenosis: A Patient-Tailored Transcatheter Aortic Valve Implantation Approach

Andreas Mitsis et al. J Cardiovasc Dev Dis. .

Abstract

Transcatheter aortic valve replacement (TAVI) has become a game changer in the management of severe aortic stenosis shifting the concept from inoperable or high-risk patients to intermediate or low surgical-risk individuals. Among devices available nowadays, there is no clear evidence that one device is better than the other or that one device is suitable for all patients. The selection of the optimal TAVI valve for every patient represents a challenging process for clinicians, given a large number of currently available devices. Consequently, understanding the advantages and disadvantages of each valve and personalising the valve selection based on patient-specific clinical and anatomical characteristics is paramount. This review article aims to both analyse the available devices in the presence of specific clinical and anatomic features and offer guidance to select the most suitable valve for a given patient.

Keywords: balloon expandable valves (BEV); self-expandable valves (SEV); surgical aortic valve replacement (SAVR); transcatheter aortic valve implantation (TAVI); transcatheter aortic valve replacement (TAVR).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evolution of the Sapien balloon-expandable valve. The device consists of a trileaflet, bovine pericardial tissue valve mounted on stainless-steel frame. The upper part has an open cell geometry to avoid obstruction and the lower part of the device is covered by a textured sealing polyethylene terephthalate material to reduce paravalvular leak.
Figure 2
Figure 2
Evolution of the CoreValve/Evolute self-expandable valve. The device consists of self-expanding trileaflet porcine pericardial tissue on a nitinol frame with a larger cell size and a shorter frame height. The external tissue wrap provides advanced sealing.
Figure 3
Figure 3
The ACURATE neo and neo2 self-expandable valve consist of a porcine pericardial tissue bio-prosthesis stitched into a self-expanding Nitinol stent and covered on the inside and outside with an anti-PVL porcine pericardial skirt. The open upper frame of the device open frame provides unrestricted access for future interventions.
Figure 4
Figure 4
The self-expandable intra-annular Portico and Navitor valve is the only self-expanding valve with intra-annular leaflets and a non-tapered stent which provides uncompromised coronary access.
Figure 5
Figure 5
The Myval balloon-expandable valve is made by a nickel-cobalt alloy frame which is created of a single design element open cell hexagons while the remainder has closed cells with higher annular radial force towards the ventricular end.
See this image and copyright information in PMC

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