Degenerative Aortic Valve Disease, its Mechanism on Progression, its Effect on the Left Ventricle and the Postoperative Results

TAVI: Trans-Catheter Aortic Valve Implantation

Author(s): Wilhelm Peter Mistiaen

Pp: 256-288 (33)

DOI: 10.2174/9781608052875113010014

* (Excluding Mailing and Handling)

Abstract

For patients deemed unfit to undergo AVR, BAV has been tried as a less traumatic alternative. Recurrence of stenosis within months has been observed, however. BAV has been abandoned, and alternatives have been explored.

Implantation of a valve through a catheter has proven experimentally feasible and has been performed for the first time in a patient in 2003. The more cumbersome transseptal technique has been replaced by the trans-arterial technique. This procedure has not always been applicable in patients with atheromatosis of the femoral and iliac arteries or of the aorta. As alternative, a trans-apical approach has been developed. TAVI might also become attractive as “valve-in-valve” procedure, for patients with a degenerated BHV.

The current procedure needs an elaborate imaging system, with a pre-procedural study of the anatomy of the aortic root. Interference with anatomical structures such as the coronary arteries and the conduction system needs to be avoided. Attachment and anchoring systems needs to be adequate, to avoid secondary displacement.

The selection of patients is problematic: the EuroSCORE tends to overestimate operative mortality of conventional AVR, especially in high risk patients. Such patients might be denied this operation unjustly. A RCT, comparing TAVI with medical treatment and with conventional AVR might seem desirable.

The early clinical and hemodynamic results in terms of TVG and AVA seem acceptable but PPVL could be a problem. A recently published RCT, which compared medical treatment or BAV with TAVI, showed superior clinical and hemodynamic results for the latter. PPVL has been considered as acceptable and has not worsened after one year. Vascular complications, bleeding an stroke have been troubling. Technical improvements with smaller delivery systems might offer relief. A second RCT has shown the non inferiority of TAVI, compared to conventional AVR, at least for the first postoperative year. TAVI offers the advantage of being less traumatic, compared to open surgery.

These results make clear that TAVI is here to stay.


Keywords: Balloon aortic valvotomy, bleeding, conventional aortic valve replacement, EuroSCORE, exclusion criteria, imaging, life expectancy, paravalvular leak, percutaneous devices, quality of life, randomized controlled trial, stroke, transapical, transarterial, vascular complications.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873352086 and j.to_ip >=873352086 )) and ((j.from_date <= 1739847744 and j.to_date >= 1739847744 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4704) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873352086 and j.to_ip >=873352086 )) and ((j.from_date <= 1739847744 and j.to_date >= 1739847744 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4704) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 873352086 and j.to_ip >=873352086 )) and ((j.from_date <= 1739847744 and j.to_date >= 1739847744 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4704)
      790μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1141 and `b`.`banner_from_date` <= 1739847744 and `b`.`banner_to_date` >= 1739847744 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.07msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1141
      • 3: 1739847744
      • 4: 1739847744
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='44984df70721471161e0184741e554f3'
      220μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    15Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        VU44oYpVP2Snulqwu7kK708dcUBRX5bEo5V390gO
        uc_cart_id
        44984df70721471161e0184741e554f3
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4704" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4704
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
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        session_attributes
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        array:5 [ "_token" => "VU44oYpVP2Snulqwu7kK708dcUBRX5bEo5V390gO" "uc_cart_id" => "44984df70721471161e0184741e554f3" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/4704" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-18 03:02:24GET/chapter/47041121917