New advances in the prevention of transcatheter aortic valve implantation failure: current and future perspectives

Abstract

Transcatheter aortic valve implantation (TAVI) represents an established and safe therapeutic alternative to surgical valve replacement for patients with severe symptomatic aortic stenosis. However, some uncertainty still persists about long‑term outcomes of this procedure. The aim of this review was to analyze the actual state of the art with focus on the new advances that are being developed to improve this therapeutic approach. Thanks to improvements in technology and materials as well as a substantial standardization of the procedure, patients undergoing TAVI are showing increasing life expectancy. Although a growing body of evidence demonstrated a convincing midterm safety profile, the very long‑ ‑term survival after TAVI still depends on the rate of bioprosthetic valve failure (BVF). Structural valve deterioration, leaflet thrombosis, prosthesis–patient mismatch, paravalvular regurgitation, and endocarditis are the main complications that threaten the preservation of valvular function. Through the understanding of these physiopathological mechanisms underlying BVF, we analyzed how the management of such valve‑related issues has evolved in the last years and how current clinical and research efforts are shifting towards the ambit of prevention of valve failure. In conclusion, in the near future, the prevention of long‑ ‑term BVF is expected to be one of the major challenges regarding TAVI. Currently, promising results can be observed in the development of new technologies and therapeutic options.