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Review
. 2022 Nov 21:9:971762.
doi: 10.3389/fcvm.2022.971762. eCollection 2022.

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Andreas S Kalogeropoulos  1   2 , Simon R Redwood  1 , Christopher J Allen  1 , Harriet Hurrell  1 , Omar Chehab  1 , Ronak Rajani  1   3 , Bernard Prendergast  1 , Tiffany Patterson  1
Affiliations
Review

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence

Andreas S Kalogeropoulos et al. Front Cardiovasc Med. .

Abstract

Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.

Keywords: TAVI; TAVR; aortic stenosis (AS); aortic valve calcification; bicuspid and tricuspid aortic valve; minimalistic approach; paravalvular aortic leak.

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Conflict of interest statement

Author SR received speaker fees from Edwards Lifesciences and served as an International Advisory Board Member for Medtronic. Author BP received institutional educational and research grants from Edwards Lifesciences, and speaker/consultancy fees from Abbott, Anteris, Microport, and Edwards Lifesciences. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
TAVI: A 20-year journey of transformative evolution from high-risk inoperable patients to the most recent European and US guidelines and low-risk younger patients along with landmark trials.
FIGURE 2
FIGURE 2
Commercially available transcatheter aortic valves.
FIGURE 3
FIGURE 3
Minimalist—single arterial access technique implantation using aortic valve leaflet calcification for THV positioning and deployment. (A) Identify calcium markers and annular plane in 3-cusp view (circled). (B) Position Sapien ULTRA 3 central balloon marker—align with annular plane and calcium marker (arrows-circles). (C) THV deployment.
FIGURE 4
FIGURE 4
TAVI future directions.
FIGURE 5
FIGURE 5
Lifetime management for younger patients < 65 years old with severe aortic stenosis. Potential interventional scenarios and associated considerations. SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.
FIGURE 6
FIGURE 6
(A) The Saranas Early Bird Bleed Monitoring System. (B) By monitoring nearby tissue bioimpedance can offer early bleeding detection. (C) The lower the bioimpedance the higher the bleeding volume.
FIGURE 7
FIGURE 7
Native cardiac conduction system and its anatomical relations with aortic valve cusps and membranous septum. (A) The penetrating bundle of His emerges at the surface of the left ventricular outflow tract beneath the membrane septum (MS). The length of the MS is equal to the distance between the aortic annulus and the bundle of His. (B) The left bundle branch emerges beneath the MS and is positioned between the right coronary cusp and non-coronary cusp. AVN, atrioventricular node; LBB, left bundle branch; LCC, left coronary cusp; PB, penetrating bundle; MS, membrane septum; NCC, non-coronary cusp; RBB, right bundle. Reproduced from Lin et al. (159).
See this image and copyright information in PMC

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