TAVI Through the Years: A Systematic Review of Progress

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology Assessment

Background:

• Transcatheter Aortic Valve Implantation (TAVI) has evolved significantly from an option for inoperable patients to a treatment for severe aortic stenosis (AS) across all operative risk categories.
• Historically, TAVI was reserved for elderly patients with high operative risk, but its application has broadened considerably over the past decade.

Purpose of the Study:

• To systematically review the evolution and comparative outcomes of Transcatheter Aortic Valve Implantation (TAVI) over the last ten years.
• To assess the changing indications and patient profiles for TAVI in managing symptomatic severe aortic stenosis (AS).

Main Methods:

• A comprehensive systematic literature search was performed across major electronic databases (MEDLINE, Embase, Web of Science, Scopus, Cochrane Library) for English-language studies published between January 2014 and December 2024.
• Keywords included "TAVI," "AF," "PPI," "aortic regurgitation," and "SAVR." Data extracted covered study design, demographics, interventions, and outcomes such as stroke, bleeding, mortality, and complications. Sensitivity analyses excluded studies with significant bias or small sample sizes.

Main Results:

• TAVI demonstrated advantages including shorter hospital stays and reduced bleeding compared to Surgical Aortic Valve Replacement (SAVR).
• TAVI showed non-inferiority to SAVR in short-term mortality but was associated with higher rates of paravalvular leaks, conduction disturbances requiring Permanent Pacemaker Implantation (PPI), and mild-to-moderate Aortic Regurgitation.
• SAVR had higher incidences of New-Onset Atrial Fibrillation (AF) and procedural bleeding, with some studies suggesting better long-term survival and reintervention-free rates, though not universally significant.

Conclusions:

• TAVI is a successful treatment for symptomatic severe aortic stenosis across varying operative risks, supported by advances in imaging.
• While TAVI offers benefits like shorter recovery and less bleeding, careful consideration of risks such as paravalvular leaks and PPI is necessary.
• Future research should explore TAVI's role in younger patients, asymptomatic severe AS, and long-term outcomes including valve durability and its use in complex conditions like bicuspid aortic valve stenosis.