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Will Transcatheter Aortic Valve Replacement (TAVR) be the Primary Therapy for Aortic Stenosis?

, MD, MS 1 , , MD, FACC, MSCAI , 1

Cardiovascular Innovations and Applications

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aortic stenosis, transcatheter aortic valve replacement, valve-in-valve

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      Abstract

      Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis (AS) or failing surgical bioprosthesis (valve-in-valve, VIV-TAVR). In TAVR, the collapsed transcatheter heart valve (THV) is introduced using the delivery system inserted from the femoral artery (preferred) or other alternative accesses (transapical, transaortic, transcarotid, subclavian/transinnominate or transcaval). The delivery system is then advanced until coaxially aligned with the aortic annulus, where the THV is deployed. This procedure can be associated with complications such as access site injury (vascular complication), paravalvar leak, cerebrovascular events and conduction disturbances. However, the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection, preprocedural planning (i.e. MDCT annular sizing), THV technology (i.e. new generation valves), and procedural techniques (i.e. minimalist TF-TAVR and alternative percutaneous access options), as well as a decrease in complications as TAVR experience grows. Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending, it is likely that TAVR will soon be approved for lower risk patients as well.

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      Most cited references 75

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      First-in-man use of a novel embolic protection device for patients undergoing transcatheter aortic valve implantation.

      We describe the first-in-human experience with a novel cerebral embolic protection device used during transcatheter aortic valve implantation (TAVI). One current challenge of TAVI is the reduction of procedural stroke. Procedural mobilisation of debris is a known source of cerebral embolisation. Mechanical protection by transient filtration of cerebral blood flow might reduce the embolic burden during TAVI. We aimed to evaluate the feasibility and safety of the Claret CE Pro™ cerebral protection device in patients undergoing TAVI.
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        Development of transcatheter aortic valve implantation (TAVI): a 20-year odyssey.

         Alain Cribier (2012)
        The development of transcatheter aortic valve implantation (TAVI) by our group has been a 20-year odyssey. In 1993, postmortem studies validated the concept of intravalvular stenting in calcific aortic stenosis. The first prototypes of balloon-expandable valves were tested in an animal model in 2000. The first-in-man implantation was performed in Rouen in 2002, rapidly followed by two prospective series in compassionate cases in our centre. TAVI took flight in 2004 in the hands of Edwards Lifesciences, with major improvements in devices and approaches. At the same time, the self-expanding CoreValve was launched. Thousands of high-surgical-risk patients were enrolled in feasibility studies, leading to the Conformité Européenne (CE) mark being granted in 2007 for the two devices. A number of postmarketing registries have shown dramatic improvements in procedural and midterm results and decreased complication rates, with more experience and improved technology. The results of the randomized PARTNER study in the USA recently confirmed the important place of TAVI in non-operable and high-surgical-risk patients. To date, more than 50,000 patients have benefited from TAVI worldwide (2300 patients in 33 centres in France in 2011) and the number is consistently increasing. An optimal multidisciplinary collaboration and formally trained experienced physicians are the keys to success. An extension of indications to lower-risk patients might be expected in the coming years but should be cautiously investigated. Ten years after the first-in-man case, TAVI is here to stay and the future is promising. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
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          Chronic pacing and adverse outcomes after transcatheter aortic valve implantation.

          Many patients undergoing transcatheter aortic valve implantation (TAVI) have a pre-existing, permanent pacemaker (PPM) or receive one as a consequence of the procedure. We hypothesised that chronic pacing may have adverse effects on TAVI outcomes.
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            Author and article information

            Affiliations
            1Structural Heart and Valve Center, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
            Author notes
            Correspondence: Peter C. Block, MD, Emory University Hospital F606, 1364 Clifton Road, Atlanta, GA 30322, USA, Tel.: +404-727-7040; Fax: 404-712-5622, E-mail: pblock@ 123456emory.edu
            Journal
            CVIA
            Cardiovascular Innovations and Applications
            CVIA
            Compuscript (Ireland )
            2009-8618
            2009-8618
            May 2016
            July 2016
            : 1
            : 3
            : 273-285
            cvia20160012 10.15212/CVIA.2016.0012
            Copyright © 2016 Cardiovascular Innovations and Applications

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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