Expanding indications of transcatheter aortic valve implantation and cornerstones of the lifetime management of patients with severe aortic stenosis

Abstract

Over the past two decades, transcatheter aortic valve implantation (TAVI) for the treatment of degenerative severe aortic valve stenosis has become a well-established therapeutic option with increasing scientific evidence. TAVI procedure indications are not determined purely by the risk of cardiac surgery and progressively, more and more consider patient’s life expectancy. Current guidelines leave "grey zones" alongside the first class recommendations for TAVI and surgical aortic valve replacement (SAVR), providing an opportunity to make optimal decision between different therapies, taking into account advantages and disadvantages of both interventions, patient's interests and local circumstances. Since patients treated with TAVI have come to be younger, several factors and different characteristics of the intervention must be considered individually (lifetime management). In addition to intraventricular conduction disturbances, pacemaker implantation, paravalvular leak, valve durability, the feasibility of percutaneous coronary interventions after TAVI and potential aortic valve reinterventions are the most important issues. The choice of the first intervention – whether it is TAVI or SAVR – is crucial, as it can determine the patient's quality of life, valve durability and the feasibility of subsequent invasive procedures.

Keywords

• aortic valve stenosis
• transcatheter aortic valve implantation
• tavi durability
• aortic valve reintervention
• lifetime management