Transcatheter aortic valve replacement: many roads lead to Rome...but the implantation technique makes the difference!

Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment strategy to surgical aortic valve replacement (SAVR) in high-risk patients and is superior to conservative management. In the currently treated patient population, which is characterised by severe comorbidities, the overall prognosis is significantly influenced by periprocedural complications such as more than mild paravalvular aortic regurgitation (AR) 1,2 . Today, with almost 100,000 implanted prostheses worldwide of the commercially available transcatheter heart valve (THV) systems, we have learned a lot about outcomes and complications after TAVR. However, so-called “next generation” THVs are eagerly awaited to further improve our results by device modifications such as paravalvular space-fillers as well as additional innovations; i.e., recapturability and repositionability. Nonetheless, we should bear in mind that – independent from the use of current and future THVs – the result of TAVR is only as good as the implantation itself and that only the perfectly implanted valve will lead to a good result for the patient. The first challenge before each TAVR procedure is the appropriate sizing of the dimensions of the aortic annulus. This cannot be measured during the procedure by direct visualisation as we can do in patients undergoing SAVR, so we must choose not only the size but also the THV type (selfexpanding vs. balloon expandable) that fits the given anatomy best 3