Performing optimal transcatheter aortic valve implantation: The need for tailored use of transcatheter valves

Abstract

Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated. To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics. This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81±9 years; 52% men; mean EuroSCORE II, 7.0±6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient. A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P<0.001). The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.