Journal of Clinical Medicine

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Special Issue Editor

Dr. Gry Dahle

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Guest Editor

Department of Cardiothoracic surgery, Oslo University Hospital, 0372 Oslo, Norway
Interests: transcatheter therapies; mini-invasive surgery; innovations; implementing new methods and ethics

Special Issue Information

Dear Colleagues,

It has now been 22 years since the first transcatheter aortic valve implantation (TAVI) implant. The indications have moved from high-risk to low-risk, as have younger patients. There has been a huge evolution in valve development and delivery systems, imaging, and procedural strategy. Still, we have the issue of durability: “Who lives longer, the valve or the patient”? With TAVI in younger patients, bicuspid valves and aortic regurgitation have to be addressed. The explant of a TAVI valve may be hazardous, but it is an increasing trend in the US.

These topics will be discussed by the opinion leaders in this Special Issue.

Dr. Gry Dahle
Guest Editor

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Keywords

how far can we expand TAVI to SAVR
the increasing number and results of TAVI explants
TAVI in bicuspid valves
TAVI solutions for aortic regurgitation
TAVI in low risk vs. younger patients
the role of artificial intelligence for TAVI planning
peri procedural care for TAVI patients

Published Papers (2 papers)

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Research

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10 pages, 1729 KiB

Open AccessArticle

German Experience with a Novel Balloon-Expandable Heart Valve Prosthesis for Transcatheter Aortic Valve Implantation—Outcomes of the MYLAND (MYvaL germAN stuDy) Study

by Timm Ubben, Eike Tigges, Won-Keun Kim, Andreas Holzamer, Ingo Breitenbach, Ralf Sodian, Jürgen Rothe, Willibald Hochholzer, Samer Hakmi and Franz-Josef Neumann

J. Clin. Med. 2024, 13(11), 3163; https://doi.org/10.3390/jcm13113163 - 28 May 2024

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Abstract

Background: The primary objective of this study was to evaluate the initial experience in Germany with the Meril Myval™ (MM) transcatheter heart valve (THV) system for the treatment of severe symptomatic aortic valve stenosis. The MM THV is a novel balloon-expandable valve with an expanded sizing matrix. Contemporary patients undergoing TAVI with the established Edwards Sapien™ (ES) THV served as the comparator group. Methods: Between 1st March and 31 August 2020 a total of 134 patients (33% female, 80.1 ± 6.7 years; EuroScore II 4.7 ± 4.8) underwent TAVI with an MM (95% transfemoral) for severe aortic stenosis at six German tertiary care centers. Results: Correct positioning of the THV was achieved in 98.5% (n = 132). Mean aortic gradients (MPG) were reduced from 42 ± 14 mmHg to 11 ± 5 mmHg. Mild postprocedural paravalvular leak (PVL) was observed in 62% (n = 82) patients, whereas only one patient had more than mild PVL. New permanent pacemaker implantation (PPI) was indicated in 15 patients (11%). Major vascular complications occurred in 6.7% (n = 9) patients. The in-hospital combined incidence of all-cause death and stroke was 4.5% (n = 6). In the comparator group that included 268 patients, the 30-day incidences of PPI, major vascular complications, and the composite of all-cause death and stroke were 16%, 1.9%, and 7.1%, respectively; MPGs were reduced from 44 ± 15 mmHg to 12.8 ± 4.6 mmHg and the more than mild PVL occurred in 0.7%. Conclusions: The MM is a promising novel THV system, with performance comparable to the established ES THVs. These findings await confirmation by ongoing randomized trials. Full article

(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)

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Review

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12 pages, 2093 KiB

Open AccessReview

Transcatheter Aortic Valve Implantation for Severe Chronic Aortic Regurgitation

by Judy Al Ahmad and Edward Danson

J. Clin. Med. 2024, 13(10), 2997; https://doi.org/10.3390/jcm13102997 - 20 May 2024

Viewed by 661

Abstract

Transcatheter aortic valve implantation (TAVI) has revolutionised the management of aortic valve disease, offering a less invasive alternative to traditional surgical valve replacement for severe aortic stenosis (AS). TAVI for pure aortic regurgitation (AR) is less well established, and, in fact, it was previously labelled as a relative contraindication. However, TAVI has been utilised for selected cases of pure or predominant AR. The primary limitations regarding the use of TAVI in AR are related to the absence of anatomical factors seen in patients with AS that have contributed to the safe and stable functioning of current-generation prostheses. These include aortic root dilatation, mobile valve leaflets and labile blood pressure within the aortic root, which may further increase the risk of valve migration and periprosthetic leak after deployment. Furthermore, patients with AR have more heterogeneous aortic root anatomies when compared to the population of patients with calcific or degenerative AS. This review article describes the current evidence for the off-label use of TAVI in pure AR and the various clinical syndromes associated with AR where there may be specific challenges in the application of TAVI. Full article

(This article belongs to the Special Issue Clinical Advances in Transcatheter Aortic Valve Replacement)

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