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Review article: Biomedical intelligence

Vol. 140 No. 4748 (2010)

Transcatheter aortic valve implantation (TAVI)

  • E Ferrari
DOI
https://doi.org/10.4414/smw.2010.13127
Cite this as:
Swiss Med Wkly. 2010;140:w13127
Published
22.11.2010

Summary

Transcatheter aortic valve therapies are the newest established techniques for the treatment of high risk patients affected by severe symptomatic aortic valve stenosis. The transapical approach requires a left anterolateral mini-thoracotomy, whereas the transfemoral method requires an adequate peripheral vascular access and can be performed fully percutaneously. Alternatively, the trans-subclavian access has been recently proposed as a third promising approach. Depending on the technique, the fine stent-valve positioning can be performed with or without contrast injections. The transapical echo-guided stent-valve implantation without angiography (the Lausanne technique) relies entirely on transoesophageal echocardiogramme imaging for the fine stent-valve positioning and it has been proved that this technique prevents the onset of postoperative contrast-related acute kidney failure. Recent published reports have shown good hospital outcomes and short-term results after transcatheter aortic valve implantation, but there are no proven advantages in using the transfemoral or the transapical technique. In particular, the transapical series have a higher mean logistic Euroscore of 27–35%, a procedural success rate above 95% and a mean 30-day mortality between 7.5 and 17.5%, whereas the transfemoral results show a lower logistic Euroscore of 23–25.5%, a procedural success rate above 90% and a 30-day mortality of 7–10.8%. Nevertheless, further clinical trials and long-term results are mandatory to confirm this positive trend. Future perspectives in transcatheter aortic valve therapies would be the development of intravascular devices for the ablation of the diseased valve leaflets and the launch of new stent-valves with improved haemodynamic, different sizes and smaller delivery systems.

References

  1. Lester SJ, Heilbron B, Gin K, Dodek A, Jue J. The natural history and rate of progression of aortic stenosis. Chest. 1998;113:1109–14.
  2. Aronow WS, Kronzon I. Prevalence and severity of valvular aortic stenosis determined by Doppler echocardiography and its association with echocardiographic and electrocardiographic left ventricular hypertrophy and physical signs of aortic stenosis in elderly patients. Am J Cardiol. 1991;67:776–7.
  3. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368:1005–11.
  4. Ross J Jr, Braunwald E. Aortic stenosis. Circulation. 1968;38:61–7.
  5. Otto CM, Mickel MC, Kennedy JW, Alderman EL, Bashore TM, Block PC, Brinker JA, Diver D, Ferguson J, Holmes DR Jr. Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation. 1994;89:642–50.
  6. Varadarajan P, Kapoor N, Bansal RC, Pai RG. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg. 2006;82:2111–5.
  7. Otto CM. Timing of aortic valve surgery. Heart. 2000;84:211–8.
  8. Kvidal P, Bergström R, Hörte LG, Ståhle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56.
  9. Schwarz F, Baumann P, Manthey J, Hoffmann M, Schuler G, Mehmel HC, Schmitz W, Kübler W. The effect of aortic valve replacement on survival. Circulation. 1982;66:1105–10.
  10. Bonow RO, Carabello BA, Kanu C, de Leon AC Jr, Faxon DP, Freed MD, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation. 2006;114:e84–231.
  11. Ferrari E, Tozzi P, Hurni M, Ruchat P, Stumpe F, von Segesser LK. Primary isolated aortic valve surgery in octogenarians. Eur J Cardiothorac Surg. 2010. (paper in press) PMID: 20304666.
  12. Asimakopoulos G, Edwards MB, Taylor KM. Aortic valve replacement in patients 80 years of age and older: survival and cause of death based on 1100 cases: collective results from the UK valve registry. Circulation. 1997;96:3403–8.
  13. Sundt TM, Bailey MS, Moon MR, Mendeloff EN, Huddleston CB, Pasque MK, Barner HB, Gay WA Jr. Quality of life after aortic valve replacement at the age of >80 years. Circulation. 2000;102:III70–4.
  14. Chukwuemeka A, Borger MA, Ivanov J, Armstrong S, Feindel CM, David TE. Valve surgery in octogenarians: a safe option with good medium-term results. J Heart Valve Dis. 2006;15:191–6.
  15. Melby SJ, Zierer A, Kaiser SP, Guthrie TJ, Keune JD, Schuessler RB, Pasque MK, Lawton JS, Moazami N, Moon MR, Damiano RJ Jr. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg. 2007;83:1651–6.
  16. Kolh P, Kerzmann A, Honore C, Comte L, Limet R. Aortic valve surgery in octogenarians: predictive factors for operative and long-term results. Eur J Cardiothorac Surg. 2007;31:600–6.
  17. Iung B, Cachier A, Baron G, Messika-Zeitoun D, Delahaye F, Tornos P, Gohlke-Bärwolf C, Boersma E, Ravaud P, Vahanian A. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005;26:2714–20.
  18. Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106:3006–8.
  19. Zhou JQ, Corno AF, Huber CH, Tozzi P, von Segesser LK. Self-expandable valved stent of large size: off-bypass implantation in pulmonary position. Eur J Cardiothorac Surg. 2003;24:212–6.
  20. Ma L, Tozzi P, Huber CH, Taub S, Gerelle G, von Segesser LK. Double-crowned valved stents for off-pump mitral valve replacement. Eur J Cardiothorac Surg. 2005;28:194–8.
  21. Andersen HR, Knudsen LL, Hasenkam JM. Transluminal implantation of artificial heart valves. Description of a new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs. Eur Heart J. 1992;13: 704–8.
  22. Corno AF, Zhou J, Tozzi P, von Segesser LK. Off-bypass implantation of a self-expandable valved stent between inferior vena cava and right atrium. Interact Cardiovasc Thorac Surg. 2003;2:166–9.
  23. Huber CH, Marty B, von Segesser LK. Acceptance and introduction of disruptive technologies – simple steps to build a fully functional pulmonary valved stent. Interact Cardiovasc Thorac Surg. 2007;6:430–2.
  24. Huber CH, Tozzi P, Corno AF, Marty B, Ruchat P, Gersbach P, Nasratulla M, von Segesser LK. Do valved stents compromise coronary flow? Eur J Cardiothorac Surg. 2004:754–9.
  25. Boudjemline Y, Bonhoeffer P. Steps toward percutaneous aortic valve replacement. Circulation. 2002;105:775–8.
  26. Cribier A, Eltchaninoff H, Tron C, Bash A, Borenstein N, Bauer F, Derumeaux G, Pontier G, Laborde F, Leon MB. Percutaneous artificial heart valves: from animal experimentation to the first human implantation in a case of calcified aortic stenosis. Arch Mal Coeur Vaiss. 2003;96:645–52.
  27. Walther T, Dewey T, Borger MA, Kempfert J, Linke A, Becht R, Falk V, Schuler G, Mohr FW, Mack M. Transapical aortic valve implantation: step by step. Ann Thorac Surg. 2009;87:276–83.
  28. Vahanian A, Alfieri OR, Al-Attar N, Antunes MJ, Bax J, Cormier B, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2008;34:1–8.
  29. Cribier A, Litzler PY, Eltchaninoff H, Godin M, Tron C, Bauer F, Bessou JP. Technique of transcatheter aortic valve implantation with the Edwards-Sapien heart valve using the transfemoral approach. Herz. 2009;34:347–56.
  30. Zierer A, Wimmer-Greinecker G, Martens S, Moritz A, Doss M. The transapical approach for aortic valve implantation. J Thorac Cardiovasc Surg. 2008;136:948–53.
  31. Al-Attar N, Ghodbane W, Himbert D, Rau C, Raffoul R, Messika-Zeitoun D, Brochet E, Vahanian A, Nataf P. Unexpected complications of transapical aortic valve implantation. Ann Thorac Surg. 2009;88:90–4.
  32. Ferrari E, Locca D, Sulzer C, Marcucci C, Rizzo E, Tozzi P, von Segesser LK. Successful transapical aortic valve implantation in a congenital bicuspid aortic valve. Ann Thorac Surg. 2010 (in press).
  33. Ferrari E, Marcucci C, Sulzer C, Rizzo E, von Segesser LK. No arterial access: a “blind flight” for a transapical aortic valve implantation (TAVI). J Heart Valve Dis. 2010;19:266–8.
  34. Walther T, Kempfert J, Borger MA, Fassl J, Falk V, Blumenstein J, Dehdashtian M, Schuler G, Mohr FW. Human minimally invasive off-pump valve-in-a-valve implantation. Ann Thorac Surg. 2008;85:1072–3.
  35. Ferrari E, Marcucci C, Sulzer C, von Segesser LK. Which available transapical transcatheter valve fits into degenerated aortic bioprostheses? Interact Cardiovasc Thorac Surg. 2010 (in press).
  36. Nietlispach F, Leipsic J, Al-Bugami S, Masson JB, Carere RG, Webb JG. CT of the ilio-femoral arteries using direct aortic contrast injection: proof of feasibility in patients screened towards percutaneous aortic valve replacement. Swiss Med Wkly. 2009;139:458–62.
  37. Strauch JT, Scherner MP, Haldenwang PL, Pfister R, Kuhn EW, Madershahian N, et al. Minimally invasive transapical aortic valve implantation and the risk of acute kidney injury. Ann Thorac Surg. 2010;89:465–70.
  38. Aregger F, Wenaweser P, Hellige GJ, Kadner A, Carrel T, Windecker S, Frey FJ. Risk of acute kidney injury in patients with severe aortic valve stenosis undergoing transcatheter valve replacement. Nephrol Dial Transplant. 2009;24:2175–9.
  39. Ferrari E, Sulzer C, Rizzo E, von Segesser LK, A fully echo-guided trans-apical aortic valve implantation, Eur J Cardiothorac Surg. 2009;36:938–40.
  40. Ferrari E, Marcucci C, Di Bernardo S, von Segesser LK. Feasibility of transapical aortic valve implantation guided by intracardiac ultrasound without angiography. J Thorac Cardiovasc Surg. 2010 (in press).
  41. Ferrari E, Sulzer C, Marcucci C, Rizzo E, Tozzi P, von Segesser LK. Transapical aortic valve implantation without angiography – proof of concept. Ann Thorac Surg. 2010;89(6):1925–32.
  42. von Segesser LK, Marty B, Ruchat P, Bogen M, Gallino A. Routine use of intravascular ultrasound for endovascular aneurysm repair: angiography is not necessary. Eur J Vasc Endovasc Surg. 2002;23:537–42.
  43. Moss RR, Ivens E, Pasupati S, Humphries K, Thompson CR, Munt B, Sinhal A, Webb JG. Role of echocardiography in percutaneous aortic valve implantation. JACC Cardiovasc Imaging. 2008;1:15–24.
  44. Ye J, Cheung A, Lichtenstein SV, Nietlispach F, Albugami S, Masson JB, Thompson CR, Munt B, Moss R, Carere RG, Jamieson WR, Webb JG. Transapical transcatheter aortic valve implantation: follow-up to 3 years. J Thorac Cardiovasc Surg. 2010;139:1107–13.
  45. Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol. 2010;55:1080–90.
  46. Walther T, Simon P, Dewey T, Wimmer-Greinecker G, Falk V, Kasimir MT, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation. 2007;116:I240–5.
  47. Wendt D, Eggebrecht H, Kahlert P, Heine T, Kottenberg E, Massoudy P, et al. Experience and learning curve with transapical aortic valve implantation. Herz. 2009;34:388–97.
  48. Himbert D, Descoutures F, Al-Attar N, Iung B, Ducrocq G, Détaint D, et al. Results of transfemoral or transapical aortic valve implantation following a uniform assessment in high-risk patients with aortic stenosis. J Am Coll Cardiol. 2009;54:303–11.
  49. Webb JG, Altwegg L, Boone RH, Cheung A, Ye J, Lichtenstein S, et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009;119:3009–16.
  50. Grube E, Buellesfeld L, Mueller R, Sauren B, Zickmann B, Nair D, et al. Progress and current status of percutaneous aortic valve replacement: results of three device generations of the CoreValve Revalving system. Circ Cardiovasc Interv. 2008;1:167–75.
  51. Tamburino C, Capodanno D, Mulè M, Scarabelli M, Cammalleri V, Barbanti M, Calafiore A, Ussia G. Procedural success and 30-day clinical outcomes after percutaneous aortic valve replacement using current third-generation self-expanding CoreValve prosthesis. J Invasive Cardiol. 2009;21:93–8.
  52. Piazza N, Grube E, Gerckens U, den Heijer P, Linke A, Luha O, et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008;4:242–9.
  53. Vandenberghe S, Salizzoni S, Bajona P, Zehr KJ, Speziali G. In vitro testing of a temporary catheter-based aortic “parachute” valve. ASAIO J. 2008;54:574–7.
  54. Salizzoni S, Bajona P, Zehr KJ, Anderson WD, Vandenberghe S, Speziali G. Transapical off-pump removal of the native aortic valve: a proof-of-concept animal study. J Thorac Cardiovasc Surg. 2009;138:468–73.
  55. Quaden R, Attmann T, Schünke M, Theisen-Kunde D, Cramer J, Lutter G. Percutaneous aortic valve replacement: endovascular resection of human aortic valve in situ. J Thorac Cardiovasc Surg. 2008;135:1081–6.
  56. Quaden R, Attmann T, Boening A, Cremer J, Lutter G. Percutaneous aortic valve replacement: resection before implantation. Eur J Cardiothorac Surg. 2005;27:836–40.
  57. Vergnat M, Henaine R, Kalejs M, Bommeli S, Ferrari E, Obadia JF, Von Segesser LK. A new self-expanding aortic stent valve with annular fixation: in vitro haemodynamic assessment. Eur J Cardiothorac Surg. 2009;35:970–6.
  58. Lauten A, Ferrari M, Petri A, Ensminger SM, Gummert JF, Boudjemline Y, et al. Experimental evaluation of the jenaclip transcatheter aortic valve. Catheter Cardiovasc Interv. 2009;74:514–9.
  59. Kalejs M, Ferrari E, von Segesser LK. Towards no-scar cardiac surgery – minimally invasive access through umbilicus for aortic valve replacement. Eur J Cardiothorac Surg. 2009;36:773–5.
  60. Tozzi P, Pawelec-Wojtalic M, Bukowska D, Ferrari E, Siniscalchi G, von Segesser LK. Endoscopic access closure for direct implantation of valved stents. Swiss Med Wkly. 2007;137:182–4.