title: The future of transcatheter aortic valve implantation.
abstract: Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.
authors.affiliation: Department of Medical Clinic I, University of Giessen, Klinikstr. 33, Gießen 35392, Germany Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany christian.hamm@innere.med.uni-giessen.de.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department Cardiac Surgery, Kerckhoff Heart Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany The Heart Hospital Baylor Plano, 1100 Allied Drive, Plano, TX 75093, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Arsalan
authors.affiliation: Cardiovascular Surgery, Baylor Health Care System, Dallas, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery; D001022:Aortic Valve Insufficiency; D001024:Aortic Valve Stenosis / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005544:Forecasting; D014943:Global Health / Q000706:statistics & numerical data; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000592:standards; D006801:Humans; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D017410:Practice Guidelines as Topic; D011475:Prosthesis Failure; D012051:Reimbursement Mechanisms; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends*; D061205:Vascular Calcification / Q000601:surgery
chemical_list: D005343:Fibrinolytic Agents
keywords: Aortic regurgitation; Aortic stenosis; Aortic valve surgery; TAVI; TAVR; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement