Vol 24, No 2 (2017)
Review articles — Interventional cardiology
Published online: 2017-02-15

open access

Page views 3527
Article views/downloads 2811
Get Citation

Connect on Social Media

Connect on Social Media

Trans-catheter aortic valve implantation: Contemporary practice and the future

Omar Aldalati, Philip MacCarthy, Rafał Dworakowski
Pubmed: 28248406
Cardiol J 2017;24(2):206-215.


With increasing life expectancy, the epidemic of valvular heart disease, especially aortic stenosis (AS), is becoming more prevalent. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative therapy for patients with significant aortic valve disease. It offers a less invasive procedure in comparison to surgical aortic valve replacement (sAVR) and an attractive substitute from the patient’s perspective. The evidence for TAVI in inoperable and high risk surgical patients is now established and in the intermediate risk group has been accumulating rapidly and is looking favourable for TAVI.

However, the full ‘TAVI story’ is still unfolding. Technological advances in devices and delivery systems are evolving with the aim to improve the function and durability of TAVI and to simplify the procedure while enhancing safety. The incidence of vascular injury and pacemaker requirement post TAVI remains an issue and further development in this regard is therefore of utmost importance, particularly as lower risk and potentially younger patients are treated. Moreover, the evidence concerning long-term durability of the TAVI prostheses continues to accumulate. Whilst TAVI is proving to be an invaluable tool for inoperable and high risk patients, more trial evidence is needed before it encompases lower risk populations and moreover, its use as a first line treatment worldwide in most healthcare systems is limited by the costs associated with the prosthesis.

Article available in PDF format

View PDF Download PDF file


  1. Mortality and life expectancy statistics in Europe. http://ec.europa.eu/eurostat/statisticsexplained/index.php/Mortality_and_life_expectancy_statistics.
  2. d'Arcy JL, Prendergast BD, Chambers JB, et al. Valvular heart disease: the next cardiac epidemic. Heart. 2011; 97(2): 91–93.
  3. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540): 1005–1011.
  4. Vahanian A, Alfieri O, Andreotti F, et al. [Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)]. G Ital Cardiol (Rome). 2013; 14(3): 167–214.
  5. Nishimura RA, Otto CM, Bonow RO, et al. ACC/AHA Task Force Members. 2014 AHA/ACC Guideline 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. Circulation. 2014; 129(23): e521–e643.
  6. Ludman PF, Moat N, de Belder MA, et al. Transcatheter aortic valve implantation in the United Kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK Transcatheter Aortic Valve Implantation (TAVI) Registry, 2007 to 2012. Circulation. 2015; 131(13): 1181–1190.
  7. Walther T, Hamm CW, Schuler G, et al. GARY Executive Board. Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements: Prospective Data From the GARY Registry. J Am Coll Cardiol. 2015; 65(20): 2173–2180.
  8. Gilard M, Eltchaninoff H, Donzeau-Gouge P, et al. FRANCE 2 Investigators, FRANCE 2 Investigators. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012; 366(18): 1705–1715.
  9. Holmes D, Nishimura R, Grover F, et al. Annual Outcomes With Transcatheter Valve Therapy. J Am Coll Cardiol. 2015; 66(25): 2813–2823.
  10. Yoon SH, Ahn JM, Hayashida K, et al. Asian TAVR Investigators. Clinical Outcomes Following Transcatheter Aortic Valve Replacement in Asian Population. JACC Cardiovasc Interv. 2016; 9(9): 926–933.
  11. Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly? EuroIntervention. 2016; 11(9): 1029–1033.
  12. Mylotte D, Osnabrugge RLJ, Windecker S, et al. Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization. J Am Coll Cardiol. 2013; 62(3): 210–219.
  13. Rampat R, Khawaja MZ, Byrne J, et al. Transcatheter Aortic Valve Replacement Using the Repositionable LOTUS Valve: United Kingdom Experience. JACC Cardiovasc Interv. 2016; 9(4): 367–372.
  14. Eksik A, Yildirim A, Gul M, et al. Comparison of Edwards Sapien XT versus Lotus Valve Devices in Terms of Electrophysiological Study Parameters in Patients Undergoing TAVI. Pacing Clin Electrophysiol. 2016; 39(10): 1132–1140.
  15. Nelson PR, Kracjer Z, Kansal N, et al. A multicenter, randomized, controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial). J Vasc Surg. 2014; 59(5): 1181–1193.
  16. Hayashida K, Lefèvre T, Chevalier B, et al. True percutaneous approach for transfemoral aortic valve implantation using the Prostar XL device: impact of learning curve on vascular complications. JACC Cardiovasc Interv. 2012; 5(2): 207–214.
  17. Dimitriadis Z, Scholtz W, Börgermann J, et al. Impact of closure devices on vascular complication and mortality rates in TAVI procedures. Int J Cardiol. 2017 [Epub ahead of print].
  18. Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation. 2013; 127(3): 397–407.
  19. Dworakowski R, Wendler O, Halliday B, et al. Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI. Heart. 2014; 100(24): 1939–1945.
  20. Bleiziffer S, Ruge H, Hörer J, et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2010; 3(5): 524–530.
  21. Ferreira ND, Caeiro D, Adão L, et al. Incidence and predictors of permanent pacemaker requirement after transcatheter aortic valve implantation with a self-expanding bioprosthesis. Pacing Clin Electrophysiol. 2010; 33(11): 1364–1372.
  22. Aldalati O, MacCarthy P. Further refining the technique: new concepts in TAVI research. EuroIntervention. 2015; 11(5): 497–501.
  23. Katsanos S, van Rosendael P, Kamperidis V, et al. Pericardial effusion following transcatheter aortic valve implantation: echocardiography and multi-detector row computed tomography evaluation. Int J Cardiovasc Imaging. 2015; 31(1): 37–43.
  24. Rezq A, Basavarajaiah S, Latib A, et al. Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study. JACC Cardiovasc Interv. 2012; 5(12): 1264–1272.
  25. https://clinicaltrials.gov/ct2/results?term=TAVR&Search=Search.
  26. Orlando R, Pennant M, Rooney S, et al. Cost-effectiveness of transcatheter aortic valve implantation (TAVI) for aortic stenosis in patients who are high risk or contraindicated for surgery: a model-based economic evaluation. Health Technol Assess. 2013; 17(33): 1–86.
  27. Reynolds MR, Magnuson EA, Lei Y, et al. PARTNER Investigators. Cost-effectiveness of transcatheter aortic valve replacement compared with surgical aortic valve replacement in high-risk patients with severe aortic stenosis: results of the PARTNER (Placement of Aortic Transcatheter Valves) trial (Cohort A). J Am Coll Cardiol. 2012; 60(25): 2683–2692.
  28. Reynolds MR, Lei Y, Wang K, et al. CoreValve US High Risk Pivotal Trial Investigators. Cost-Effectiveness of Transcatheter Aortic Valve Replacement With a Self-Expanding Prosthesis Versus Surgical Aortic Valve Replacement. J Am Coll Cardiol. 2016; 67(1): 29–38.
  29. Dvir D. First look at long-term durability of transcatheter heart valves: assessment of valve function up to 10 years after implantation; Oral presentation, EuroPCR. 2016: Paris.
  30. Durand E, Eltchaninoff H, Canville A, et al. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. Am J Cardiol. 2015; 115(8): 1116–1122.
  31. Leon MB, Smith CR, Mack M, et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–1607.
  32. Smith C, Leon M, Mack M, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. New Engl J Med. 2011; 364(23): 2187–2198.
  33. Yakubov SJ, Adams DH, Watson DR, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014; 63(19): 1972–1981.
  34. Adams DH, Popma JJ, Reardon MJ, et al. U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014; 370(19): 1790–1798.
  35. Leon M, Smith C, Mack M, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New Engl J Med. 2016; 374(17): 1609–1620.
  36. Thyregod HG, Steinbrüchel DA, Ihlemann N, et al. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis: 1-Year Results From the All-Comers NOTION Randomized Clinical Trial. J Am Coll Cardiol. 2015; 65(20): 2184–2194.
  37. Meredith IT, Walton A, Walters DL, et al. Mid-term outcomes in patients following transcatheter aortic valve implantation in the CoreValve Australia and New Zealand Study. Heart Lung Circ. 2015; 24(3): 281–290.
  38. Lansky AJ, Schofer J, Tchetche D, et al. A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial. Eur Heart J. 2015; 36(31): 2070–2078.
  39. Dangas GD, Lefèvre T, Kupatt C, et al. BRAVO-3 Investigators. Bivalirudin Versus Heparin Anticoagulation in Transcatheter Aortic Valve Replacement: The Randomized BRAVO-3 Trial. J Am Coll Cardiol. 2015; 66(25): 2860–2868.
  40. Wendt D, Kleinbongard P, Knipp S, et al. Intraaortic Protection From Embolization in Patients Undergoing Transaortic Transcatheter Aortic Valve Implantation. Ann Thorac Surg. 2015; 100(2): 686–691.