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Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review
Bimmer E Claessen1,2, Gilbert H L Tang3, Annapoorna S Kini1
1Division of Cardiology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
JAMA Cardiology
|September 9, 2020
Summary
Transcatheter aortic valve replacement (TAVR) is a safe alternative for aortic stenosis. This review details current and investigational TAVR devices, noting unique features but no device superiority.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Aortic valve stenosis (AS) is the most common acquired valvular heart disease in developed nations.
- Transcatheter aortic valve replacement (TAVR) is established as a safe and effective alternative to surgical aortic valve replacement for severe symptomatic AS across all risk profiles.
- The current landscape includes three commercially available TAVR devices in the US, with additional devices in clinical trials.
Purpose of the Study:
- To provide an overview of the design features of various TAVR devices.
- To review the clinical outcomes associated with different TAVR devices.
- To compare commercially available and investigational TAVR devices.
Main Methods:
- Review of existing literature on TAVR devices.
- Analysis of design characteristics and engineering features of TAVR systems.
- Synthesis of clinical trial data and outcomes for TAVR procedures.
Main Results:
- Each TAVR device possesses unique strengths and limitations due to fundamental differences in engineering.
- No single TAVR device has demonstrated superiority over others in large-scale head-to-head comparisons.
- New iterations of TAVR devices are rapidly emerging.
Conclusions:
- Patient and anatomy-related factors may favor specific TAVR device designs.
- The rapid evolution of TAVR technology necessitates ongoing evaluation.
- Further research is needed to establish device-specific indications and comparative effectiveness.
