How to improve patient outcomes following TAVI in 2024? Recent advances

Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of aortic stenosis, particularly among elderly patients. The world's first TAVI procedure was performed in 2002 by Professor Cribier. It was approved for clinical use in Europe in 2007, followed by approval in the United States in 2011. It has since been introduced into clinical practice throughout Europe, and there has been a remarkable increase both in the number of procedures and in the number of centers performing TAVI. Recent findings endorse its additional application in lower-risk populations, suggesting a transformative shift in the field of interventional cardiology. This review article thoroughly explores the recent advances and key considerations aimed at enhancing patient outcomes following TAVI. Key areas of focus include valve durability, paravalvular leak management, valve-in-valve procedures, and the implications and management of coronary artery disease in these patients. We highlight the importance of selecting valves with favorable hemodynamics, minimal coronary risk, and optimal durability, especially for younger, lower-risk patients. Paravalvular leak remains a significant concern; thus, pre-procedural planning and immediate corrective measures are crucial to mitigate its impact. The increasing need for valve-in-valve interventions underscores the importance of the strategic initial valve choice with a forward-looking perspective. Additionally, emerging strategies such as transcatheter leaflet laceration to prevent coronary obstruction during reinterventions, are examined. This review synthesizes current research and clinical practice, providing a roadmap for enhancing TAVI outcomes through technological advances and strategic procedural planning. The findings and recommendations presented aim to optimize long-term patient prognosis, ensuring that TAVI remains a leading solution for aortic stenosis in an increasing variety of patients.