New Horizons in Transcatheter Aortic Valve Replacement: Expectations and Preparations

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Transcatheter aortic valve replacement (TAVR) has revolutionized severe aortic stenosis management across all surgical risks.
• Expanding TAVR indications, including for asymptomatic patients and younger individuals, necessitate a focus on lifetime valve management.
• Recent trials and FDA approvals underscore the growing importance and evolving landscape of TAVR.

Purpose of the Study:

• To review recent advancements in TAVR technology, procedural techniques, and patient selection strategies.
• To emphasize the critical role of optimal initial valve choice and prevention of prosthesis-patient mismatch (PPM).
• To discuss planning for future interventions like valve-in-valve (ViV) TAVR and novel procedural techniques.

Main Methods:

• Narrative review of current literature and recent developments in TAVR.
• Analysis of emerging device technologies, procedural innovations, and patient selection criteria.
• Examination of strategies for managing complex cases and planning for reinterventions.

Main Results:

• Significant progress in TAVR device technology and procedural techniques has expanded treatment options.
• New strategies like bioprosthetic valve fracture and leaflet modification address challenges such as elevated gradients and coronary obstruction.
• Optimal first valve selection and planning for future valve-in-valve TAVR are crucial for long-term success.

Conclusions:

• TAVR is increasingly central to the lifetime management of aortic valve disease, supported by technological and clinical advancements.
• Careful procedural planning, including consideration of prosthesis-patient mismatch and reintervention, is essential.
• Multidisciplinary heart team collaboration remains paramount for optimizing long-term TAVR outcomes.