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TAVI in 2022: Remaining issues and future direction.

John G Webb1, Philipp Blanke2, David Meier1

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Summary
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Transcatheter aortic valve implantation (TAVI) is increasingly used in younger patients. Long-term complications and valve durability are key concerns, necessitating tailored lifetime management strategies for this growing population.

Keywords:
Aortic stenosisDétérioration de la valve structurelleGestion de vieImplantation percutanée de valve aortiqueLifetime managementRétrécissement aortiqueStructural valve deteriorationTranscatheter aortic valve implantation

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis.
  • TAVI is increasingly offered to younger, lower-risk patients with longer life expectancies.
  • Long-term implications of TAVI complications and bioprosthetic valve degeneration are significant concerns in this demographic.

Purpose of the Study:

  • To review the challenges of TAVI in lower-risk, younger populations.
  • To summarize current strategies for lifetime management of aortic stenosis in these patients.
  • To discuss the feasibility and outcomes of repeat TAVI procedures.

Main Methods:

  • Literature review of TAVI outcomes, complications, and durability.
  • Analysis of strategies for managing aortic stenosis over a patient's lifetime.
  • Examination of redo TAVI procedures and potential complications like coronary obstruction.

Main Results:

  • Potential long-term impacts of mild complications (e.g., paravalvular regurgitation, AV block) are greater in younger patients.
  • Transcatheter heart valve (THV) degeneration necessitates consideration of repeat interventions.
  • Redo TAVI is feasible, but anatomical/device factors can preclude repeat procedures due to coronary obstruction risk.

Conclusions:

  • Lifetime management strategies for TAVI in younger patients require careful consideration.
  • Approaches include SAVR first, TAVI then SAVR, or TAVI then TAVI.
  • A tailored approach considering patient factors and therapy trade-offs is essential for optimal outcomes.