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Transcatheter aortic valve implantation (TAVI) is advancing, with valve-in-valve procedures routine and bicuspid valve treatment improving. Current evidence suggests single antiplatelet therapy is safer than dual, and early intervention for aortic stenosis is key.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Valvular Heart Disease

Background:

  • Transcatheter aortic valve implantation (TAVI) is a cornerstone treatment for aortic stenosis.
  • Significant advancements have been made, but challenges remain in specific patient populations and therapeutic strategies.

Purpose of the Study:

  • To provide an overview of current major challenges and advancements in the field of TAVI.
  • To discuss optimal strategies for valve-in-valve procedures, bicuspid aortic valve treatment, antithrombotic therapy, and the timing of intervention.

Main Methods:

  • Review of available supporting data and current literature on TAVI.
  • Discussion of clinical outcomes, risks, and benefits associated with different TAVI approaches and patient profiles.

Main Results:

  • Valve-in-valve procedures are established with good outcomes, minimizing patient-prosthesis mismatch.
  • Treatment of bicuspid aortic valve anatomy is improving with technology and experience, despite lack of randomized data.
  • Dual-antiplatelet therapy post-TAVI may increase harm compared to single antiplatelet therapy due to thrombosis risk.
  • A trend towards earlier intervention for aortic stenosis, before extra-valvular effects, is emerging.

Conclusions:

  • TAVI is the preferred treatment for high/intermediate risk patients and an alternative for some low-risk patients.
  • Optimizing TAVI outcomes requires addressing specific challenges like bicuspid valves and refining antithrombotic strategies.
  • Shifting towards earlier intervention based on evolving understanding of aortic stenosis progression is crucial.