Transcatheter aortic valve implantation: emerging role in poor left ventricular function severe aortic stenosis?

Abstract

Surgical aortic valve replacement (AVR) has long been recognized as the gold standard treatment for symptomatic severe aortic stenosis improving symptoms, survival and functional class. Recently, transcatheter aortic valve implantation (TAVI) has also become an established procedure for the treatment of higher risk patients with symptomatic severe aortic stenosis.1 These include the frail, elderly patient with multiple co-morbidities and disabilities. TAVI has been shown to successfully reduce aortic valve gradients to a similar degree as conventional AVR but the incidence of paravalvular aortic regurgitation (AR) is significantly higher.2, 3 Compared to conventional AVR, TAVI has a shorter recovery period, avoids a sternotomy and cardiopulmonary bypass, and has a lower risk of bleeding, acute kidney injury, atrial fibrillation and early mortality, but the risk of vascular complications, pacemaker implantations and cardiac perforations are higher.1, 3 Stroke rates were initially reported to be higher following TAVI compared to conventional AVR but recent studies suggest no difference in stroke rates.3