Will Transcatheter Aortic Valve Replacement (TAVR) be the Primary Therapy for Aortic Stenosis?

Abstract

Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis (AS) or failing surgical bioprosthesis (valve-in-valve, VIV-TAVR). In TAVR, the collapsed transcatheter heart valve (THV) is introduced using the delivery system inserted from the femoral artery (preferred) or other alternative accesses (transapical, transaortic, transcarotid, subclavian/transinnominate or transcaval). The delivery system is then advanced until coaxially aligned with the aortic annulus, where the THV is deployed. This procedure can be associated with complications such as access site injury (vascular complication), paravalvar leak, cerebrovascular events and conduction disturbances. However, the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection, preprocedural planning (i.e. MDCT annular sizing), THV technology (i.e. new generation valves), and procedural techniques (i.e. minimalist TF-TAVR and alternative percutaneous access options), as well as a decrease in complications as TAVR experience grows. Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending, it is likely that TAVR will soon be approved for lower risk patients as well.