Abstract
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis across all surgical risk categories. Access is an important aspect when planning for and performing TAVI. The superiority of a transfemoral (TF) approach compared to a transthoracic (transapical, direct aortic) approach has been demonstrated in several studies. Recently, the introduction of intravascular lithotripsy (IVL) has made it possible to treat patients with calcified iliofemoral disease by TF approach. This article aimed to provide a comprehensive overview on the following aspects: (1) preprocedural planning for IVL-assisted TF-TAVI; (2) procedural aspects in IVL-assisted TF-TAVI; (3) outcomes of IVL-assisted TF-TAVI in an experienced TAVI center; and (4) literature review and discussion of this new emerging approach.
Highlights
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis (AS) across all surgical risk categories [1, 2]
This article aimed to provide a comprehensive overview on the following aspects: [1] preprocedural planning for intravascular lithotripsy (IVL)-assisted TF-TAVI; [2] procedural aspects in IVL-assisted TF-TAVI; [3] outcomes of IVL-assisted TF-TAVI in an experienced TAVI center; and [4] literature review and discussion of this new emerging approach
The use of the transapical approach fell from 13% in 2016 to 0.8% in 2018, while the use of the TF approach increased from 85% in 2016 to 94% in 2018. [6] reported the largest series of IVL-assisted TF-TAVI so far; in all 42 patients, a successful delivery of the TAVI device was achieved [6]
Summary
Transcatheter aortic valve implantation (TAVI) is currently an established therapy for elderly patients with symptomatic severe aortic valve stenosis (AS) across all surgical risk categories [1, 2]. Access is an important aspect when planning for and performing TAVI. The superiority of a transfemoral (TF) approach as compared to a transapical or direct aortic approach has been demonstrated in a meta-analysis of randomized controlled trials comparing TAVI and surgical aortic valve replacement (SAVR) [3]. TF access should be the first choice for TAVI whenever the patient’s anatomy allows this approach. Iliofemoral arterial disease is not uncommon in TAVI candidates with advanced age and multiple medical co-morbidities. Improved insertion profile and flexibility of TAVI delivery systems has allowed to increase the percentage of TAVI procedures performed by TF approach
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