Paris, France, 16 May 2023. Within 20 years of its first appearance on the clinical stage transfemoral transcatheter aortic valve implantation (TF-TAVI) has become an established treatment option for patients with symptomatic severe aortic stenosis (AS) that is supported by Class IA recommendations in current European and US guidelines on the management of valvular heart disease. Technological innovations and procedural refinements have made TAVI a safe and streamlined intervention, while accumulating long-term follow-up data suggest that durability will be comparable to surgical aortic bioprostheses.
In daily practice, Heart Teams may choose TAVI as an initial treatment option for patients with prolonged life expectancy (>10 years). This requires higher standards regarding the index TAVI procedure planning and execution, aiming at minimising potential complications (paravalvular regurgitation, mismatch, pace-maker implantation) and keeping an easy access to the coronary arteries. But with the expectation that many of those patients will require a second valve intervention, being older at the time of this reintervention, a second percutaneous procedure seems likely. However, implanting a second transcatheter heart valve (THV) may be a complex and difficult procedure depending on the baseline anatomy and technical choices made at the time of initial transcatheter valve implantation. Equally, surgical explantation of a degenerated THV device may be more complex than a simple surgical aortic valve replacement. Careful advance planning is therefore essential when contemplating the prospect of TAVI in younger patients and the Heart Team needs to consider these issues carefully when conceiving an overall lifetime treatment strategy. Further randomised clinical trials comparing surgery and different TAVI therapies will be indicated in the future for this problematic younger patient population who will likely require multiple sequential procedures during their life history with AS.
This topic will come under the spotlight in a Main Arena “Partners in Learning” session prepared by EuroPCR in collaboration with TCT on Tuesday, 16 May from 12:00 -13:30. The programme, which incorporates a live case from Toulouse, will encompass the latest clinical evidence governing the application of TAVI in the lifetime journey of younger patients with AS, identify clinical and anatomical factors that determine the choice between TAVI and surgical aortic valve replacement, and demonstrate how valve design, implantation technique and in-depth anatomical analysis can influence long term outcomes and future treatment options after the index TAVI procedure. Don’t miss it!
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