Current issues in transcatheter aortic valve replacement
- Aortic stenosis is the most common valvular disease worldwide. With transcatheter aortic valve replacement (TAVR) being increasingly expanded to lower-risk populations, several challenging issues remain to be solved. The present review aims at discussing modern approaches to such issues as well as the current status of TAVR. TAVR has undergone several developments in the recent years: an increased use of transfemoral access, the development of prostheses in order to adapt to challenging anatomies, improved delivery systems with repositioning features, and outer skirts aiming at reducing paravalvular leak. The indication of TAVR is increasingly being expanded to patients with lower surgical risk. The main clinical trials supporting such expansion are reviewed and the latest data on low-risk patients are discussed. A number of challenges need still to be addressed and are also reviewed in this paper: the need for updated international guidelines including the latest evidence; a reduction of main complications such as permanent pacemaker implantation, paravalvular leak, and stroke (and its potential prevention by using anti-embolic protection devices); the appropriate role of TAVR in patients with concomitant cardiac ischemic disease; and durability of bio-prosthetic implanted valves. Finally, the future perspectives for TAVR use and next device developments are discussed.
Author: | Silvia Mas-PeiroORCiDGND, Stephan Fichtlscherer, Claudia Walther, Mariuca Vasa-NicoteraORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-551575 |
DOI: | https://doi.org/10.21037/jtd.2020.01.10 |
ISSN: | 2077-6624 |
Parent Title (English): | Journal of thoracic disease |
Publisher: | Pioneer Bioscience Publ. |
Place of publication: | Hong Kong |
Document Type: | Article |
Language: | English |
Year of Completion: | 2020 |
Year of first Publication: | 2020 |
Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
Release Date: | 2020/09/10 |
Tag: | aortic stenosis; complications; low-risk; transcatheter aortic valve replacement (TAVR) |
Volume: | 12 |
Issue: | 4 |
Page Number: | 16 |
First Page: | 1665 |
Last Page: | 1680 |
Note: | https://creativecommons.org/licenses/by-nc-nd/4.0/ |
HeBIS-PPN: | 471003611 |
Institutes: | Medizin / Medizin |
Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
Sammlungen: | Universitätspublikationen |
Licence (German): | Creative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0 |