Transcatheter Aortic Valve Replacement/methods

ABC

Editorial

Transcatheter Aortic Valve Implant in Latin America – We will Get There!

As with percutaneous coronary intervention, the Transcatheter Aortic Valve Implantation (TAVI) is making great strides toward overcoming the surgical approach and becoming the predominant procedure in treating aortic stenosis. Since the first percutaneous implantation made by Dr. Alain Cribier, who turns 2 decades old this year, TAVI has demonstrated, study after study, robust evidence of its efficacy and safety. At each stage of this journey, the challenges were successively overcome both by the improvement of the devices and the skills acquired by the operators, which allowed us to move consistently from the prohibitive surgical risk scenario to the low-risk scenario in just over 15 years.^– Furthermore, evolution is unfolding^– – ongoing studies investigate the expansion of TAVI for young patient populations, bicuspid aortic valve, asymptomatic and even pure aortic regurgitation.

Today the million-dollar question is about the durability of devices that, in part, starts to be answered. In 2019, Thyregod et al. published the 5-year result of the NOTION study (The Nordic Aortic Valve Intervention Trial), showing no differences in either the primary composite endpoint of death from any cause, stroke or heart attack (TAVR 38% vs. SAVR 36%; p=0.86) as in individual events. More recently, at the American College of Cardiology Congress (ACC 2022), Michael Reardon presented the 5-year results combining the CoreValve US Pivotal and SURTAVI studies showing that in intermediate- or high-risk patients, the rate of valve structural deterioration was significantly lower in the TAVI group compared to the surgical group (2.57% x 4.38%; p=0.0095). Nevertheless, these data are still insufficient to answer whether TAVI will be the Gold Standard for treating aortic valve diseases, regardless of etiology, age or type of dysfunction.

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ABCIC

Case Report

Calcic Embolization with Acute Myocardial Infarction and Ventricular Septal Defect after Bioprosthetic Mitral Valve Implantation using the Valve-in-Valve Technique

Marcelo Tadeu Blumer Peron et al. Márcio Silva Miguel Lima Renato Garcia Lisboa Borges Guilherme Sobreira Spina … Henrique Barbosa Ribeiro Jeane Mike Tsutsui

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IJCS

Editorial

Clinical Characteristics and Mid-Term Follow-Up of Patients with Severe Aortic Stenosis and Those not Eligible for TAVI

Gilberto Eder de Oliveira Júnior et al. Rogerio Sarmento-Leite

Aortic stenosis is an insidious disease with a long-term period of latency. It progresses rapidly after symptoms appear, esulting in a high mortality rate (approximately 50% in the first 2 years) in untreated symptomatic patients, with sudden death being common in these individuals.

Approximately 30% of the patients aged 75 years or over are not candidates for surgical procedure due to their advanced age, female sex, functional class, operatory emergency, ventricular dysfunction, pulmonary hypertension, previous heart surgery, associated coronary artery disease, among others. In the age range of patients in their 80s, those who remain in clinical treatment have a survival rate of 65.8% in the first year and 41.8% in the second year of follow-up.

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ABC

Editorial

Computational Analysis of Fluid Dynamics in the Transcatheter Aortic Valve Replacement

Marco A. Gutierrez

Transcatheter aortic valve replacement (TAVR), a minimally invasive heart surgery, was introduced by Cribier et al. as an alternative to the traditional open-heart surgery in the treatment of individuals with severe aortic valve stenosis and at high surgical risk due to advanced age or the presence of multiple comorbidities. After the first pioneering efforts, the advent of innovative prosthetic valves, and more technologically refined approaches and devices, the use of TAVR for patients with intermediate surgical risk has been a worldwide trend. However, variation in the prosthetic valve positioning and orientation post TAVR procedure can produce significant changes in the aortic hemodynamics and the corresponding stresses in the vessel wall.

Within the aorta, there are two categories of vessel wall stress. The first category of stress is the result of the friction between the moving blood and the vessel wall, which is proportional to the blood speed, moving away from the intimate layer of the vessel wall. This kind of stress is known as wall shear stress (WSS). The second category of stress is due to the variation in pulse pressure generated during the cardiac cycle. In this category, there are circumferential, axial and radial stress transferred to all vessel wall layers. With advancing age, the aorta enlarges, the arch changes shape from a near-perfect semicircle, and the vessel generally becomes more tortuous. Moreover, the change in the natural curvature of the aorta introduces secondary flow dynamics and flow asymmetry, which directly influence WSS distribution and magnitude over the vessel wall.

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ABC

Editorial

New Method Improves the Assessment of Aortic Regurgitation Grade during TAVR by Aortography

Henrique B. Ribeiro

Transcatheter aortic valve replacement (TAVR) is a rapidly expanding alternative to surgical aortic valve replacement for patients deemed inoperable or at high or intermediate operative risk. Yet, residual aortic regurgitation (AR) secondary to paravalvular leaks (PVL) remains a procedural limitation. Although residual AR after TAVR is frequent, affecting up to approximately 70% of the treated patients,^– it is moderate to severe in approximately 12% of these and steadily below 5% with current-generation devices, which come with specific sealing features. Noteworthy, moderate/severe AR has a detrimental clinical impact after TAVR, with a 3-fold increase in 30-day mortality and a 2.3-fold increase in 1-year mortality. Thus, its accurate assessment and quantification with a multimodality approach is key for appropriate utilization of additional procedures to reduce PVL, such as balloon post-dilatation (BPD), valve-in-valve, or leak closure.^,

While Doppler echocardiography has been the most common method to assess AR following TAVR, its accurate quantification is challenging since AR jets are often multiple and eccentric.^,^– Therefore, other methods for proper AR assessment have been evaluated in recent years, such as 3D echocardiography, hemodynamic AR index, aortography and even cardiovascular magnetic resonance, each one with its specific advantages and disadvantages.^,^,

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Transcatheter Aortic Valve Implant in Latin America – We will Get There!

Calcic Embolization with Acute Myocardial Infarction and Ventricular Septal Defect after Bioprosthetic Mitral Valve Implantation using the Valve-in-Valve Technique

Clinical Characteristics and Mid-Term Follow-Up of Patients with Severe Aortic Stenosis and Those not Eligible for TAVI

Computational Analysis of Fluid Dynamics in the Transcatheter Aortic Valve Replacement

New Method Improves the Assessment of Aortic Regurgitation Grade during TAVR by Aortography

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