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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transcatheter aortic valve implantation: status and challenges
Gregory A Fishbein1, Frederick J Schoen2, Michael C Fishbein1
1Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 13-145, Los Angeles, CA 90095-1732.
Insights
Transcatheter aortic valve implantation offers a less invasive option for aortic stenosis. Pathologist involvement is crucial for improving device safety and patient outcomes in this evolving technology.
Area of Science:
- Cardiovascular Medicine
- Biomaterials Science
- Surgical Innovation
Background:
- Calcific aortic valve disease is a leading cause of valvular heart disease in the elderly, often necessitating valve replacement.
- Transcatheter aortic valve implantation (TAVI) presents a less invasive alternative to traditional surgical aortic valve replacement, particularly for high-risk or inoperable patients with aortic stenosis.
Purpose of the Study:
- To review the essential characteristics of transcatheter aortic valve implantation devices.
- To identify current complications associated with TAVI and discuss future developmental goals.
- To highlight the critical role of pathology in TAVI research and development.
Main Methods:
- Literature review and analysis of current TAVI device requirements and performance.
- Examination of reported complications related to TAVI procedures and devices.
- Discussion of future directions for TAVI technology enhancement.
Main Results:
- TAVI devices require biocompatibility, excellent hemodynamics, ease of insertion, secure anchoring, and durability without increased thrombosis or infection risk.
- Complications are linked to insertion site, implantation location (aorta, coronary ostia, left ventricle base), and device design.
- Unanticipated complications are expected with novel technologies.
Conclusions:
- Future TAVI device development should focus on enhancing effectiveness, durability, safety, and ease of implantation to improve patient outcomes.
- Pathological examination of excised TAVI devices is vital for understanding complications and guiding future improvements.
Abstract:
Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection. To date, complications are related to the site of entry for insertion, the site of implantation (aorta, coronary ostia, base of left ventricle), and to the structure and design of the inserted device. However, as with any novel technology unanticipated complications will develop. Goals for future development will be to make the devices more effective, more durable, safer, and easier to implant, so as to further improve outcome for patients with severe aortic stenosis. The pathologist participating in research and development, and examination of excised devices will have a critical role in improving outcome for these patients.
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