Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug;10(4):2183-2199.
doi: 10.1002/ehf2.14435. Epub 2023 Jul 10.

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

Kensuke Matsushita  1   2 , Benjamin Marchandot  1 , Antonin Trimaille  1   2 , Sandy Hmadeh  2 , Marion Kibler  1 , Joe Heger  1 , Adrien Carmona  1 , Sebastien Hess  1 , Antje Reydel  1 , Laurence Jesel  1   2 , Patrick Ohlmann  1 , Valerie Schini-Kerth  2 , Olivier Morel  1   2
Affiliations
Review

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

Kensuke Matsushita et al. ESC Heart Fail. 2023 Aug.

Abstract

Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.

Keywords: Cardiac remodelling; Heart failure; Transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

K.M. received a grant from Edwards Lifesciences (THV‐F20‐142). The other authors have reported that they have no relationship to disclose.

Figures

Figure 1
Figure 1
Adverse cardiac effects of aortic stenosis. LV, left ventricular; MR, mitral regurgitation; RV, right ventricular; TR, tricuspid regurgitation. Images were adapted from smart.servier.com by Kensuke Matsushita, 2022, https://creativecommons.org/licenses/by/3.0/.
Figure 2
Figure 2
Cardiac structural and functional change after transcatheter aortic valve implantation (TAVI). LV, left ventricular; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; PA, pulmonary artery; RV, right ventricular; TR, tricuspid regurgitation. Image courtesy of Edwards Lifesciences Corporation.
Figure 3
Figure 3
Patient and procedural factors associated with heart failure (HF) hospitalization following transcatheter aortic valve implantation (TAVI). LV, left ventricular.
Figure 4
Figure 4
Suggested medical treatments for patients with heart failure (HF) following transcatheter aortic valve implantation (TAVI). LVEF, left ventricular ejection fraction; RAS, renin–angiotensin system; SGLT2, sodium–glucose co‐transporter 2. Images were adapted from smart.servier.com by Kensuke Matsushita, 2022, https://creativecommons.org/licenses/by/3.0/, and provided by Edwards Lifesciences Corporation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC, Bavaria JE, Kodali S, Brown DL, Bowers B, Dewey TM, Svensson LG, Tuzcu M, Moses JW, Williams MR, Siegel RJ, Akin JJ, Anderson WN, Pocock S, Smith CR, Leon MB. Transcatheter aortic‐valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012; 366: 1696–1704. - PubMed
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG. Transcatheter or surgical aortic‐valve replacement in intermediate‐risk patients. N Engl J Med. 2016; 374: 1609–1620. - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR. Transcatheter aortic‐valve replacement with a balloon‐expandable valve in low‐risk patients. N Engl J Med. 2019; 380: 1695–1705. - PubMed
    1. Auffret V, Bakhti A, Leurent G, Bedossa M, Tomasi J, Belhaj Soulami R, Verhoye JP, Donal E, Galli E, Loirat A, Sharobeem S, Sost G, Le Guellec M, Boulmier D, Le Breton H. Determinants and impact of heart failure readmission following transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2020; 13: e008959. - PubMed
    1. Goel SS, Kleiman NS, Zoghbi WA, Reardon MJ, Kapadia SR. Renin‐angiotensin system blockade in aortic stenosis: implications before and after aortic valve replacement. J Am Heart Assoc. 2020; 9: e016911. - PMC - PubMed

Publication types