title: Open issues in transcatheter aortic valve implantation. Part 2: procedural issues and outcomes after transcatheter aortic valve implantation.
abstract: This article provides an overview on procedure-related issues and uncertainties in outcomes after transcatheter aortic valve implantation (TAVI). The different access sites and how to select them in an individual patient are discussed. Also, the occurrence and potential predictors of aortic regurgitation (AR) after TAVI are addressed. The different methods to quantify AR are reviewed, and it appears that accurate and reproducible quantification is suboptimal. Complications such as prosthesis-patient mismatch and conduction abnormalities (and need for permanent pacemaker) are discussed, as well as cerebrovascular events, which emphasize the development of optimal anti-coagulative strategies. Finally, recent registries have shown the adoption of TAVI in the real world, but longer follow-up studies are needed to evaluate the outcome (but also prosthesis durability). Additionally, future studies are briefly discussed, which will address the use of TAVI in pure AR and lower-risk patients.
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands j.j.bax@lumc.nl.
authors: Jeroen J
authors: JJ
authors: Bax
authors: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2300 RC, Leiden, The Netherlands.
authors: Victoria
authors: V
authors: Delgado
authors: Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK.
authors: Vinayak
authors: V
authors: Bapat
authors: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors: Helmut
authors: H
authors: Baumgartner
authors: Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors: Jean P
authors: JP
authors: Collet
authors: Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Essen, Germany.
authors: Raimund
authors: R
authors: Erbel
authors: Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors: Christian
authors: C
authors: Hamm
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Arie P
authors: AP
authors: Kappetein
authors: St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Jonathon
authors: J
authors: Leipsic
authors: Columbia University Medical Center, Center for Interventional Vascular Therapy, New York Presbyterian Hospital, New York, USA.
authors: Martin B
authors: MB
authors: Leon
authors: Cardiovascular Department, King's College Hospital, London, UK.
authors: Philip
authors: P
authors: MacCarthy
authors: Interventional Cardiology, McGill University Health Center, Montreal, Canada Cardiovascular Surgery, German Heart Center Munich, Bavaria, Germany.
authors: Nicolo
authors: N
authors: Piazza
authors: Quebec Heart and Lung Institute, Québec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Baylor Heart and Vascular Institute and the Departments of Internal Medicine (Division of Cardiology) and Pathology, Baylor University Medical Center, Dallas, TX, USA.
authors: William C
authors: WC
authors: Roberts
authors: Department of Cardiology, Laval University, Quebec, Canada.
authors: Josep
authors: J
authors: Rodés-Cabau
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Patrick W
authors: PW
authors: Serruys
authors: Department of Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK.
authors: Martyn
authors: M
authors: Thomas
authors: Bichat Hospital, University Paris VII, Paris, France.
authors: Alec
authors: A
authors: Vahanian
authors: St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: John
authors: J
authors: Webb
authors: Cardiac Imaging Department, University Hospital Ramon y Cajal, Madrid, Spain.
authors: Jose Luis
authors: JL
authors: Zamorano
authors: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors: Stephan
authors: S
authors: Windecker
mesh_terms: D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000517:prevention & control; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D001705:Bioprosthesis; D057791:Cardiac Imaging Techniques; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005544:Forecasting; D006801:Humans; D010138:Pacemaker, Artificial; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011379:Prognosis; D011475:Prosthesis Failure; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Access site; Aortic regurgitation; Complications; Registries; Transcatheter aortic valve implantation