Aortic Valve Transcatheter Intervention

Complications and Solutions

Marco Zimarino, Ron Waksman, Ignacio J. Amat-Santos, Corrado Tamburino, Marco Zimarino, Ron Waksman, Ignacio J. Amat-Santos, Corrado Tamburino

• Publisher: Wiley-Blackwell
• Year: 2021
• Print ISBN: 9781119720591
• eBook ISBN: 9781119720607
• Edition: 1
• Topic: Medicine
• Subtopic: Cardiology

Aortic Valve Transcatheter Intervention

Calcific aortic stenosis (AS) is the most common heart valve anomaly, with a largely age-dependent prevalence, a calculated annual incidence rate in the range of 4-5% in general populations and up to 6% in patients aged 75 years and over.

Surgical aortic valve replacement (SAVR) was previously the only option available to patients with symptomatic, severe aortic stenosis. After the first-in-human transcatheter aortic valve implantation (TAVI) was performed by Alain Cribier in 2002, the treatment strategy for patients with symptomatic AS has been revolutionized. Since then, TAVI has grown exponentially, as a result of accruing evidence demonstrating safety and efficacy, and reduced invasiveness compared with SAVR. TAVI devices are continuously expanding to include several valve design options. As this strategy is continuously evolving to treat younger patients and lower-risk populations, aside from the long-term durability of the valve systems, procedural safety will become the focus of newer-generation devices.

This book is a practical handbook devoted to the optimization of TAVI procedures, through a focused containment of complications. Through an integrated evaluation of the clinical status, imaging techniques and laboratory findings, the authors provide readers with clear messages on preventive and therapeutic recommendations.

1
Introduction

Marco Zimarino^1,2 and Corrado Tamburino³

¹ Institute of Cardiology “G. d’Annunzio” University, Chieti, Italy

² Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy

³ Azienda Ospedaliero-Universitaria Policlinico “G. Rodolico‐San Marco”, University of Catania, Catania, Italy

With the dramatic reduction of rheumatic disease and the increase in life expectancy, valvular diseases are now mostly degenerative in industrialized countries [1]. Calcific aortic stenosis (AS) is the most common heart valve anomaly, with a largely age‐dependent prevalence, a calculated annual incidence rate in the range of 4–5‰ in general populations and a marked increase up to 6% in patients ≥75 years of age [2, 3].

Surgical aortic valve replacement (SAVR) was previously the only option available to patients with symptomatic, severe aortic stenosis, without which a median survival of ~2 years was to be expected [4].

After the first‐in‐human transcatheter aortic valve implantation (TAVI) performed by Alain Cribier in 2002 [5], the treatment strategy for patients with symptomatic aortic stenosis has been revolutionized. In over 15 years, penetration of TAVI has grown exponentially, as a result of accruing evidence demonstrating safety and efficacy, and reduced invasiveness compared with SAVR.

Favorable outcomes of TAVI were documented in randomized clinical trials among compassionate and inoperable cases [6], then comparing outcomes with SAVR in high‐risk patients [7–9] and more recently in intermediate‐risk populations [10, 11]. On the basis of such evidence, guidelines from both American Heart Association (AHA)/American College of Cardiology (ACC)/Society of Thoracic Surgery (STS) [12] and after the Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trial [11], European Society of Cardiology (ESC)/European Association of Cardio‐Thoracic Surgery (EACTS) [13] recommend SAVR for symptomatic AS in low‐risk patients, TAVI in patients deemed not suitable for surgery; in patients >75 years old at intermediate surgical risk (STS or EuroSCORE II ≥4), guidelines recommend that the decision between SAVR and TAVI should be made by the Heart Team, with TAVI “being favored” in elderly patients suitable for transfemoral access (Table 1.1).

Moreover, TAVI devices have expanded to include several valve design options, allowing a dramatic increase in the number of patients who might benefit from this evolving technology [14].

TAVI systems can be currently divided into balloon‐expandable valves, self‐expanding valves, or devices with a controlled‐release deployment method (Figure 1.1). At present, the most robust clinical data and resultant market share have been dominated by the SAPIEN and CoreValve devices, both currently commercialized with their third‐generation systems.

Table 1.1 Current recommendations for TAVI in patients with aortic valve disease.

Patient profile, as assessed by the Heart Team	ACC/AHA/STS guidelines [12]	ESC/EACTS guidelines [13]
Severe AS, inoperable	Class I, LOE A	Class I, LOE B
Severe AS, high surgical risk	Class I, LOE A	Class I, LOE B^b
Severe AS, intermediate surgical risk^a STS score or Euroscore II ≥ 4%	Class IIa, LOE B
Severe AS, low surgical risk^a STS score or Euroscore II < 4%	Not recommended SAVR: class I, LOE A	Not recommended SAVR: class I, LOE B
Bioprosthetic valve failure	Class IIa, LOE B	Reasonable alternative if the patient is at increased surgical risk

LOE = level of evidence.

STS = Society of Thoracic Surgeons; score calculator is available at http://riskcalc.sts.org/stswebriskcalc/#/calculate.

EuroSCORE = European System for Cardiac Operative Risk Evaluation; score calculator is available at http://www.euroscore.org/calc.html.

^a Without other risk factors not included in these scores, such as frailty, porcelain aorta, sequelae of chest radiation.

^b The decision between SAVR and TAVI should be made by the Heart Team a...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• List of Contributors
• Foreword
• 1 Introduction
• Part I: General Complications
• Part II: Specific Complications
• Index
• End User License Agreement