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Transcatheter Aortic Valve Replacement: Challenges and Future Directions
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Transcatheter Aortic Valve Replacement: Challenges and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 25 November 2024 | Viewed by 3010

Special Issue Editors

Dr. Walid Ben-Ali

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada
Interests: structural valve procedures; artificial intelligence; simulation
Special Issues, Collections and Topics in MDPI journals
Dr. Anita W. Asgar

E-Mail Website
Guest Editor
Interventional Cardiology Department, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada
Interests: structural valve procedures; artificial intelligence; simulation
Dr. Thomas E. Modine

E-Mail Website
Guest Editor
Unité Médico-Chirugical, CHU de Bordeaux, University of Bordeaux, Bordeaux, France
Interests: structural valve procedures; artificial intelligence; simulation

Special Issue Information

Dear Colleagues,

TAVI is now the favoured treatment option for a large number of patients who present with symptomatic severe aortic stenosis (with more than one million implants worldwide). Indeed, recent intermediate and low-risk trials had confirmed the non-inferiority and even the superiority of TAVI over surgical aortic valve replacement (SAVR) for some outcomes, such as early safety benefits, faster discharge from hospital, fewer rehospitalizations, and durability. Do these trials herald the end of isolated SAVR? Despite these very encouraging findings from these trials, about one third of patients in PARTNER 3 trial and 15% of the patients in the Evolut Low-Risk Trial failed the screening process. Therefore, the generalizability of these results is not as obvious as we are led to believe. In this Special Issue, we will consider limitations of the transition to TAVI in younger patients, as well as discuss challenges associated with expanding TAVI indications in bicuspid aortic valves, aortic regurgitation, small annuli, VIV, and TAV in TAV procedures, by highlighting ongoing trials and identifying areas of unmet needs in which continued refinements are required for optimizing cerebral embolic protection, using artificial intelligence plans, and guiding and predicting TAVR procedure results.

Dr. Walid Ben-Ali
Dr. Anita W. Asgar
Dr. Thomas E. Modine
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • transcatheter aortic valve replacement
  • aortic valve
  • TAVR
  • challenges
  • future directions

Published Papers (4 papers)

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Research

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13 pages, 910 KiB  
Article
Prognosis and Predictor Factors of Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement: A Retrospective Analysis of the Post-Transcatheter Aortic Replacement Clairval Hospital Registry
by Vassili Panagides, Emna Sakka, Edouard Cheneau, Ahmed Bouharaoua, Jacques Vicat, Elisabeth Leude-Vaillant, Philippe Rochas, Frédéric Collet and Marie-Paule Giacomoni
J. Clin. Med. 2024, 13(11), 3050; https://doi.org/10.3390/jcm13113050 - 22 May 2024
Viewed by 506
Abstract
Background/Objectives: Despite procedural improvements, post-transcatheter aortic valve replacement (TAVR) conduction disorders remain high. Analyzing the data from a monocentric TAVR registry, this study aims to determine predictive factors for PPI (primary outcome), the indication for PPI, and long-term outcomes among these patients [...] Read more.
Background/Objectives: Despite procedural improvements, post-transcatheter aortic valve replacement (TAVR) conduction disorders remain high. Analyzing the data from a monocentric TAVR registry, this study aims to determine predictive factors for PPI (primary outcome), the indication for PPI, and long-term outcomes among these patients (secondary outcomes). Methods: Conducted at Clairval Hospital in Marseille, France, this retrospective study included all consecutive patients from June 2012 to June 2019. Clinical, electrocardiographic, echocardiographic, and procedural data were collected, with outcomes assessed annually. Logistic regression identified PPI predictors and survival analyses were performed. Results: Of the 1458 patients initially considered, 1157 patients were included. PPI was needed in 21.5% of patients, primarily for third-degree atrioventricular block (46.4%). Predictor factors for PPI included baseline right bundle branch block (ORadj 2.49, 95% CI 1.44 to 4.30; p = 0.001), longer baseline QRS duration (ORadj 1.01, 95% CI 1.00 to1.02, p = 0.002), and self-expandable valves (ORadj 1.82, 95% CI, 1.09 to 3.03; p = 0.021). Seven-year estimated mortality was higher in PPI (43.3%) vs. non-PPI patients (30.9%) (log rank p = 0.048). PPI was an independent predictive factor of death (ORadj 2.49, 95% CI 1.4 to 4.3; p = 0.002). Conclusions: This study reveals elevated rates of PPI post-TAVR associated with increased mortality. These results underscore the pressing necessity to refine our practices, delineate precise indications, and enhance the long-term prognosis for implanted patients. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Challenges and Future Directions)
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11 pages, 3783 KiB  
Article
Intravascular Lithotripsy-Assisted Transfemoral Transcatheter Aortic Valve Implantation in Patients with Severe Iliofemoral Calcifications: Expanding Transfemoral Indications
by Matthias Linder, David Grundmann, Caroline Kellner, Till Demal, Lara Waldschmidt, Oliver Bhadra, Sebastian Ludwig, Lisa Voigtländer, Ina von der Heide, Nicole Nebel, Laura Hannen, Johannes Schirmer, Hermann Reichenspurner, Stefan Blankenberg, Lenard Conradi, Niklas Schofer, Andreas Schäfer and Moritz Seiffert
J. Clin. Med. 2024, 13(5), 1480; https://doi.org/10.3390/jcm13051480 - 4 Mar 2024
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Abstract
(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes [...] Read more.
(1) Background: Transfemoral transcatheter aortic valve implantation (TAVI) has become the standard treatment for most patients with severe symptomatic aortic stenosis. Intravascular lithotripsy may facilitate transfemoral TAVI (IVL-TAVI) even in patients with severely calcified iliofemoral disease. We assessed technical aspects and clinical outcomes of this novel approach compared to alternative transaxillary access (TAX-TAVI). (2) Methods: IVL-TAVI was performed for severe iliofemoral calcifications precluding standard transfemoral access in 30 patients from 2019 to 2022 at a single academic heart center. IVL was performed as part of the TAVI procedure in all cases. Results were compared to a control group of 44 TAX-TAVI procedures performed for the same indication from 2016 to 2021. The safety outcome was a composite of all-cause death, stroke, access-related bleeding ≥ type 2 within 24 h and major vascular access site complications at 30 days. The efficacy outcome was defined as a technical success according to VARC-3. (3) Results: Median age was 78.2 [74.3, 82.6] years, 45.9% were female and mean STS-PROM was 3.6% [2.3, 6.0]. Iliofemoral calcifications were more severe in the IVL-TAVI vs. TAX-TAVI groups (lesion length: 63.0 mm [48.6, 80.3] vs. 48.5 mm [33.1, 68.8]; p = 0.043, severe calcification at target lesion: 90.0% vs. 68.2%; p = 0.047, and median arc calcification 360.0° [297.5, 360.0] vs. 360.0° [180.0, 360.0]; p = 0.033). Technical success was achieved in 93.3% vs. 81.8% (p = 0.187) in IVL- and TAX-TAVI and the safety outcome occurred in 10.0% vs. 31.8% in IVL- and TAX-TAVI (p = 0.047), respectively. (4) Conclusions: IVL-assisted transfemoral TAVI was feasible and safe with favorable outcomes compared to TAX-TAVI. IVL may further expand the number of patients eligible for transfemoral TAVI and may help overcome limitations of an alternative access. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Challenges and Future Directions)
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10 pages, 1703 KiB  
Article
Prognostic Implication of Intestinal Wall Edema in Patients with Aortic Stenosis Receiving Trans-Catheter Aortic Valve Replacement
by Kousuke Akao, Teruhiko Imamura, Shuhei Tanaka, Hiroshi Onoda, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno and Koichiro Kinugawa
J. Clin. Med. 2023, 12(24), 7658; https://doi.org/10.3390/jcm12247658 - 13 Dec 2023
Cited by 1 | Viewed by 754
Abstract
Background: A recently proposed mechanism, the intestinal–cardiovascular relationship, serves as a framework to elucidate the interplay between these two systems. In our investigation, we assessed the prognostic implications of colon wall thickness, a marker correlated with intestinal congestion and dysfunction, in patients diagnosed [...] Read more.
Background: A recently proposed mechanism, the intestinal–cardiovascular relationship, serves as a framework to elucidate the interplay between these two systems. In our investigation, we assessed the prognostic implications of colon wall thickness, a marker correlated with intestinal congestion and dysfunction, in patients diagnosed with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Methods: Patients diagnosed with severe aortic stenosis who underwent TAVR at our institution during the period spanning 2015 to 2022 were retrospectively enrolled. As part of the institutional protocol, patients underwent abdominal computed tomography upon admission, preceding TAVR. Our analysis aimed to assess the influence of colon wall thickness on the occurrence of either all-cause mortality or readmission due to heart failure within a two-year period. Results: A total of 345 patients were included. The median age was 85 (82, 88) years, and 99 patients were male. Baseline colon wall thickness was distributed widely, with a median value of 2.2 (2.0, 2.5) mm. Patients with thicker colon walls tended to have lower pulmonary artery pulsatility index values, indicating more impaired right ventricular function and more advanced malnutrition. A thicker colon wall was independently associated with 2-year death or heart failure readmission with a hazard ratio of 2.02 (95% confidence interval 1.01–14.07), adjusted for hemoglobin, age, and plasma B-type natriuretic peptide levels (p = 0.049), and significantly stratified the primary endpoint at a cutoff of 2.7 mm (25% versus 10%, p = 0.005). Conclusions: Our initial observation revealed that a thicker baseline colon wall correlated with increased rates of mid-term mortality and readmission due to heart failure subsequent to TAVR. Developing a comprehensive understanding of the underlying causality necessitates further in-depth investigations through subsequent studies. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Challenges and Future Directions)
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Review

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15 pages, 1365 KiB  
Review
Alternative Access for TAVR: Choosing the Right Pathway
by Katherine Lutz, Karla M. Asturias, Jasmine Garg, Abhushan Poudyal, Gurion Lantz, Harsh Golwala, Julie Doberne, Amani Politano, Howard K. Song and Firas Zahr
J. Clin. Med. 2024, 13(12), 3386; https://doi.org/10.3390/jcm13123386 - 9 Jun 2024
Viewed by 558
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment option for patients with severe aortic stenosis regardless of surgical risk, particularly in those with a high and prohibitive risk. Since the advent of TAVR, transfemoral access has been the standard of [...] Read more.
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment option for patients with severe aortic stenosis regardless of surgical risk, particularly in those with a high and prohibitive risk. Since the advent of TAVR, transfemoral access has been the standard of care. However, given comorbidities and anatomical limitations, a proportion of patients are not good candidates for a transfemoral approach. Alternative access, including transapical, transaortic, transaxillary, transsubclavian, transcarotid, and transcaval, can be considered. Each alternative access has advantages and disadvantages, so the vascular route should be tailored to the patient’s characteristics. However, there is no standardized algorithm when choosing the optimal alternative vascular access. In this review, we analyzed the evolution and current evidence for the most common alternative access for TAVR and proposed an algorithm for choosing the optimal vascular access in this patient population. Full article
(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement: Challenges and Future Directions)
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