Martin B Leon1, Hemal Gada2, Gregory P Fontana3. 1. Center for Interventional Vascular Therapy, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY. Electronic address: ml2398@columbia.edu. 2. Center for Interventional Vascular Therapy, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY. 3. Lenox Hill Heart & Vascular Institute of New York, Lennox Hill Hospital, North Shore - LIJ Health Care System, Manhasset, NY.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a novel less-invasive therapy for high-risk patients with severe aortic stenosis (AS). Despite the impressive clinical growth of TAVR, there are many challenges as well as future opportunities. RESULTS: The heart valve team serves as the central vehicle for determining appropriate case selection. Considerations which impact clinical therapy decisions include frailty assessments and defining clinical "futility". There are many controversial procedural issues; choice of vascular access site, valve sizing, adjunctive imaging, and post-dilatation strategies. Complications associated with TAVR (strokes, vascular and bleeding events, para-valvular regurgitation, and conduction abnormalities) must be improved and will require procedural and/or technology enhancements. TAVR site training mandates a rigorous commitment to established society and sponsor guidelines. In the future, TAVR clinical indications should extend to bioprosthetic valve failure, intermediate risk patients, and other clinical scenarios, based upon well conducted clinical trials. New TAVR systems have been developed which should further optimize clinical outcomes, by reducing device profile, providing retrievable features, and preventing para-valvular regurgitation. Other accessory devices, such as cerebral protection to prevent strokes, are also being developed and evaluated in clinical studies. SUMMARY: TAVR is a worthwhile addition to the armamentarium of therapies for patients with AS. Current limitations are important to recognize and future opportunities to improve clinical outcomes are being explored.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a novel less-invasive therapy for high-risk patients with severe aortic stenosis (AS). Despite the impressive clinical growth of TAVR, there are many challenges as well as future opportunities. RESULTS: The heart valve team serves as the central vehicle for determining appropriate case selection. Considerations which impact clinical therapy decisions include frailty assessments and defining clinical "futility". There are many controversial procedural issues; choice of vascular access site, valve sizing, adjunctive imaging, and post-dilatation strategies. Complications associated with TAVR (strokes, vascular and bleeding events, para-valvular regurgitation, and conduction abnormalities) must be improved and will require procedural and/or technology enhancements. TAVR site training mandates a rigorous commitment to established society and sponsor guidelines. In the future, TAVR clinical indications should extend to bioprosthetic valve failure, intermediate risk patients, and other clinical scenarios, based upon well conducted clinical trials. New TAVR systems have been developed which should further optimize clinical outcomes, by reducing device profile, providing retrievable features, and preventing para-valvular regurgitation. Other accessory devices, such as cerebral protection to prevent strokes, are also being developed and evaluated in clinical studies. SUMMARY: TAVR is a worthwhile addition to the armamentarium of therapies for patients with AS. Current limitations are important to recognize and future opportunities to improve clinical outcomes are being explored.
Authors: Miha Mrak; Jana Ambrožič; Špela Mušič; Simon Terseglav; Bojan Kontestabile; Nikola Lakič; Matjaž Bunc Journal: Wien Klin Wochenschr Date: 2016-03-16 Impact factor: 1.704
Authors: Sandra B Lauck; Jennifer A Gibson; Jennifer Baumbusch; Sandra L Carroll; Leslie Achtem; Gil Kimel; Cindy Nordquist; Anson Cheung; Robert H Boone; Jian Ye; David A Wood; John G Webb Journal: Curr Opin Support Palliat Care Date: 2016-03 Impact factor: 2.302