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AORTIC STENOSIS

Aortic Stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America.1 It is present in approximately 2% of the general population with a rising prevalence in the elderly (up to 6% in patients above 85 years old).2-4

Symptomatic AS has significant effects on a patient’s health and quality of life5,6 and many will have cardiovascular and other comorbidities, for example, other valvular diseases, diabetes mellitus, hypertension and peripheral vascular disease.7-11

The concept of TAVI involves the use of a stent-mounted bioprosthetic valve which is deployed in the aortic position using vascular catheterisation techniques. This approach avoids sternotomy and cardiopulmonary bypass, required for surgical procedures.32

The procedure is typically performed in a catheterization room or hybrid room under fluoroscopic and echocardiographic guidance. TAVI involves
arterial, retrograde access to the aortic valve. While the transfemoral approach is most commonly applied, other approaches include transapical,
direct aortic, subclavian, transcarotid, or transcaval access.

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Early outcomes on Epic Max platfrom

Cleveland clinic (US) experience: Early outcomes and a perspective on porcine vs. bovine

TAVI Summit - Cardiac imaging

Cardiac imaging in AS - bioprosthetic valve dysfunction
 

M. Saad

TAVI Summit - Cardiac imaging and morphology

Cardiac imaging in AS - cardiac damage and morphology focus
 

A. Cook

TAVI Summit - Cardiac imaging

Cardiac imaging in AS - cardiac damage
 

L. Sondergaard

TAVI Summit - Cardiac imaging and morphology

Cardiac imaging in AS - conduction system and morphology focus
 

A. Cook

TAVI Summit - Cardiac imaging

Cardiac imaging in AS - conduction system
 

D. Buckert

TAVI Summit - Cardiac imaging and morphology

Cardiac imaging in AS - coronary access and morphology focus
 

A. Cook

TAVI Summit - Cardiac imaging

Cardiac imaging in AS - coronary access
 

M. Mullen

TAVI Summit - Live case from Berlin

Live case from Berlin on refining TAVI
 

H. Dreker, A. Unbehaun, M. Kukucka and Team SHIP

TAVI Summit - PreTAVR CT analysis

New indications in the horizon - PreTAVR CR analysis
 

W.K. Kim

HUB

PCR LV 2021: Navitor™ 30-day outcomes

PCR London Valves 2021: Navitor™ with FlexNav™ TAVI system overview and 30 days outcomes

PCR LV 2021: Navitor™ Looking ahead

PCR London Valves 2021: Navitor™ – impact of hemodynamics and coronary accessibility   

PCR LV 2021: Navitor™ Live-in-a-box

PCR London Valves 2021: Navitor™ with FlexNav™ Live-in-a box

EuroPCR 2022: TAVI 1yr outcomes

EuroPCR 2022: One-year outcomes from a next-gen TAVI device with an active sealing cuff

ESC 2021: HF & VHD Guidelines

ESC 2021: The Essentials of 2021 ESC Heart Failure and ESC/EACTS Guidelines for the management of valvular heart disease

References
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  2. Lindroos M, Kupari M, Heikkilä J et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol. 1993;21(5):1220–1225. doi.org/10.1016/0735-1097(93)90249-Z.
  3. Osnabrugge RLJ, Mylotte D, Head SJ et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol. 2013;62(11):1002–1012. doi.org/10.1016/j.jacc.2013.05.015.
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  9. Maisano F, Worthley S, Rodés-Cabau J et al. Early commercial experience from transcatheter aortic valve implantation using the Portico™ bioprosthetic valve: 30-day outcomes in the multicentre PORTICO-1 study. EuroIntervention. 2018;14(8):886–893. doi.org/10.4244/EIJ-D-18-00343.
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  13. Czarny MJ et al. Diagnosis and management of valvular aortic stenosis. Clin Med Insights Cardiol. 2014;8(Suppl 1):15–24. doi.org/10.4137/CMC.S15716.
  14. Nishimura RA, Otto CM, Bonow RO et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148(1):e1–e132. doi.org/10.1016/j.jtcvs.2014.05.014.
  15. Zakkar M, Bryan AJ, Angelini GD. Aortic stenosis: diagnosis and management. BMJ. 2016;355:i5425. doi.org/10.1136/bmj.i5425.
  16. Indolfi C, Bartorelli AL, Berti S et al. Updated clinical indications for transcatheter aortic valve implantation in patients with severe aortic stenosis: expert opinion of the Italian Society of Cardiology and GISE. J Cardiovasc Med (Hagerstown). 2018;19(5):197–210. doi.org/10.2459/JCM.0000000000000636.
  17. Grimard BH, Safford RE, Burns EL. Aortic stenosis: diagnosis and treatment. Am Fam Physician. 2016;93(5):371–378. www.aafp.org/pubs/afp/issues/2016/0301/p371.html.
  18. Vahanian A, Beyersdorf F, Praz F et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561–632. doi.org/10.1093/eurheartj/ehab395
  19. Kanwar A, Thaden JJ, Nkomo VT. Management of patients with aortic valve stenosis. Mayo Clin Proc. 2018;93(4):488-508. doi.org/10.1016/j.mayocp.2018.01.020.
  20. “Aortic Valve Stenosis - Diagnosis and Treatment - Mayo Clinic.” Aortic Valve Stenosis - Diagnosis and Treatment - Mayo Clinic, 18 August 2022, www.mayoclinic.org/diseases-conditions/aortic-stenosis/diagnosis-treatment/drc-20353145 (accessed May 2023).
  21. Ram E, Sternik L, Lipey A, et al. Clinical and echocardiographic outcomes after aortic valve repair in patients with bicuspid or unicuspid aortic valve. Isr Med Assoc J. 2018;20(7):423–428. www.ima.org.il/FilesUploadPublic/IMAJ/0/294/147319.pdf.
  22. Martín M, Lorca R, Rozado J, et al. Bicuspid aortic valve syndrome: a multidisciplinary approach for a complex entity. J Thoracic Dis. 2017;9(Suppl 6):S454–S464. doi.org/10.21037/jtd.2017.05.11.
  23. Généreux P, Stone GW, O'Gara PT et al. Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2016;67(19):2263–2288. doi.org/10.1016/j.jacc.2016.02.057.
  24. Lund O. Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation. 1990;82(1):124–139. doi.org/10.1161/01.CIR.82.1.124.
  25. Nashef SA, Roques F, Sharples LD et al. EuroSCORE II. Eur J Cardiothorac Surg. 2012;41(4):734–744;discussion 744–745. doi.org/10.1093/ejcts/ezs043.
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  28. Thourani VH, Suri RM, Gunter RL et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg. 2015;99(1):55–61. doi.org/10.1016/j.athoracsur.2014.06.050.
  29. Brown JM, O’Brien SM, Wu C et al. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137(1):82–90. doi.org/10.1016/j.jtcvs.2008.08.015.
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