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  • Review Article
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New devices for TAVI: technologies and initial clinical experiences

Key Points

  • The introduction of transcatheter aortic valve implantation (TAVI) has substantially changed the treatment of aortic stenosis in high-risk surgical patients in the past 10 years

  • Problems with the first-generation TAVI devices include increased rates of vascular complications, neurological events, rhythm disturbances, and paravalvular leakage

  • The extension of TAVI to young and low-risk patients with aortic stenosis requires further technological improvements

  • New-generation TAVI devices specifically designed to overcome the limitations of the first-generation devices are currently in the early stages of clinical evaluation

Abstract

Treatment of aortic stenosis in high-risk surgical patients has been modified in the past 10 years owing to the introduction of transcatheter aortic valve implantation (TAVI). Several issues affecting outcomes with implantation of the first-generation TAVI devices remain unresolved, including haemorrhagic and vascular complications, neurological events, rhythm disturbances, and paravalvular leakage. Further technological improvements are, therefore, required before the indications for TAVI can be extended to young and low-risk patients with aortic stenosis. Many new-generation TAVI devices are currently in the early stages of clinical evaluation. Modifications in the new devices include the ability to reposition the valve before final deployment, features to reduce paravalvular leakage, and the introduction of low-profile delivery systems. The aim of this Review is to provide an overview of the new-generation transcatheter valvular technologies, including initial clinical reports.

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Figure 1: Aortogram of a Direct Flow Medical® valve (Direct Flow Medical, USA).
Figure 2: Model of an Engager® valve (Medtronic, USA) in situ.
Figure 3: Aortogram of a Medtronic Corevalve Evolut® (Medtronic, USA) valve implanted within a degenerated stented aortic bioprosthesis (valve in valve procedure).
Figure 4: Aortogram of Lotus® (Boston Scientific, USA) valve after final release.

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Acknowledgements

We would like to thank the other members of the TAVI team at San Raffaele University Hospital—Dr Paolo Denti, Dr Micaela Cioni, and Dr Nicola Buzzatti—for their support.

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M. Taramasso researched data for the article, discussed its content, and wrote, reviewed, and edited the manuscript. A. Pozzoli researched data for the article, and wrote, reviewed, and edited the manuscript. A. Latib, G. La Canna, A. Colombo, F. Maisano, and O. Alfieri discussed the content and reviewed and edited the manuscript before submission.

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Correspondence to Maurizio Taramasso.

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The authors declare no competing financial interests.

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Taramasso, M., Pozzoli, A., Latib, A. et al. New devices for TAVI: technologies and initial clinical experiences. Nat Rev Cardiol 11, 157–167 (2014). https://doi.org/10.1038/nrcardio.2013.221

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