TAVI Through the Years: A Systematic Review of Progress

Transcatheter Aortic Valve Implantation (TAVI) has evolved over the years and now is being used in the management of patients with symptomatic severe aortic stenosis (AS) in categories of high, intermediate, and even low operative risk. Previously TAVI was used as an option only in inoperable or high operative risk elderly patients. Our systematic review gives an idea of how TAVI has evolved in use over the last ten years.

A comprehensive literature search was conducted across electronic databases, including MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library. This research used keywords such as "TAVI," "AF," "PPI," "aortic regurgitation," and Surgical Aortic Valve Replacement (SAVR) and included only those studies that were published in English between January 2014 and December 2024. The intervention is TAVI. Extracted data included study design, sample size, participant demographics, details of the intervention, control conditions, and outcome metrics. Outcomes noted were stroke, cardiovascular outcomes, procedural complications, cerebrovascular incidents, vascular outcomes, bleeding, length of hospital stay, and mortality. Sensitivity analyses were conducted, excluding studies with significant bias or small sample sizes (fewer than 10 participants). Based on the study findings, TAVI demonstrates significant advantages in terms of shorter hospital stays, reduced bleeding, and non inferiority to SAVR in short-term mortality outcomes. However, TAVI is associated with higher rates of paravalvular leaks, conduction disturbances requiring Permanent Pacemaker Implantation, and mild-to-moderate Aortic Regurgitation. SAVR patients had higher incidences of New-Onset Atrial Fibrillation and procedural bleeding. Long-term survival and freedom from reintervention were slightly better in SAVR patients in certain studies, although not universally significant. Both procedures showed comparable rates of stroke and Myocardial Infarction in most studies, emphasizing the need to tailor treatment based on individual patient profiles. In our systematic review of TAVI we have covered the application of TAVI in different patients with varying anatomical and clinical phenotypes.

TAVI has been successful in the treatment of symptomatic severe AS and the recent advances in radiological imaging have created a path to explore different anatomical variations. Various trials have already established TAVI as a viable treatment in elderly patients with high and intermediate operative risk, while certain studies also advocated the use of TAVI in patients with low risk.

The expansion of TAVI to manage patients in other horizons involving younger patients with asymptomatic severe AS, and long-term outcomes of valve durability and moderate AS in combination with cardiac failure bicuspid aortic valve stenosis and pure native aortic regurgitation are however still under research.