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Future of transcatheter aortic valve implantation — evolving clinical indications

Abstract

Accumulating clinical experience and technological improvements have provided the basis for transcatheter aortic valve implantation (TAVI) to emerge as a well-established means for treating patients with severe symptomatic aortic stenosis at high or prohibitive surgical risk. During this decade, TAVI has emerged as a valid alternative to surgical aortic valve replacement in patients at intermediate surgical risk, and several studies are currently being performed to evaluate the role of TAVI in patients at low surgical risk. Furthermore, promising, but preliminary, data are emerging on the efficacy of TAVI for treating patients with bicuspid aortic valve disease, as well as patients with pure aortic regurgitation. In this Perspectives article, we summarize the evolving indications for TAVI, and give our opinion on the future perspectives for this procedure.

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Figure 1: Latest-generation transcatheter heart valves.
Figure 2: Randomized clinical trials of TAVI versus SAVR in patients at intermediate surgical risk.
Figure 3: Valve haemodynamics and paravalvular aortic regurgitation after TAVI.
Figure 4: TAVI for bicuspid aortic valve disease.
Figure 5: The JenaValve.

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Acknowledgements

The authors thank Mélanie Côté (Québec Heart & Lung Institute, Canada) for her help in preparing the Figures. T.R.-G. receives support from a grant from the Fundacion Alfonso Martin Escudero (Madrid, Spain). J.R.-C. holds the Canadian Research Chair 'Famille Jacques Larivière' for the Development of Structural Heart Disease Interventions.

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R.P. and J.R.-C wrote the manuscript and provided substantial contribution to the discussion of content. All the authors researched data for the article, and reviewed and/or edited the manuscript before submission.

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Correspondence to Josep Rodés-Cabau.

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Competing interests

C.C. has received a fellowship grant from Edwards Lifesciences. J.R.-C. has received research grants from Edwards Lifesciences and Medtronic. The other authors declare no competing interests.

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Puri, R., Chamandi, C., Rodriguez-Gabella, T. et al. Future of transcatheter aortic valve implantation — evolving clinical indications. Nat Rev Cardiol 15, 57–65 (2018). https://doi.org/10.1038/nrcardio.2017.116

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