Transcatheter aortic valve replacement: potential use in lower-risk aortic stenosis

Alessandra Laricchia, Arif a. Khokhar, Francesco Gallo, Francesco Giannini, Antonio Colombo, Azeem Latib, Antonio Mangieri

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: The widespread use of transcatheter aortic valve implantation (TAVI) is expanding to low-risk patients. Nevertheless, a low clinical risk does not always correspond to a low procedural risk for the percutaneous approach. Areas covered: The initial trials on TAVI in low-risk populations had encouraging results, showing non-inferiority in comparison to surgical aortic valve replacement (SAVR). However, the low-risk definition is based on risk score calculators developed for the surgical setting and not including other specific features that are more relevant to TAVI and can affect procedural outcomes. For example, the presence of bicuspid aortic valves, high calcific burden, low coronary height or conduction disturbances is all potentially associated with suboptimal results or even procedural complications. In addition, the lack of longer follow-up prevents us to draw conclusions about long-term outcomes, including data about valve durability and coronary re-access. Expert opinion: Although current evidence suggest similar results for TAVI and SAVR in low-risk populations, there are some technical and procedural limitations that still need to be addressed in order to close the gap between TAVI and surgery. Optimal, lasting results with a low rate of procedural complications are highly expected in low-risk, otherwise healthy subjects, with potential for longevity.

Original languageEnglish (US)
Pages (from-to)723-731
Number of pages9
JournalExpert Review of Cardiovascular Therapy
Volume18
Issue number10
DOIs
StatePublished - 2020
Externally publishedYes

Keywords

  • Aortic stenosis
  • SAVR
  • TAVI
  • low-risk population
  • risk prediction

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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