Skip to main content
SpringerLink
Log in

Transcatheter Aortic Valve Replacement: Management of High-Risk Patients and Complex Procedures

  • Chapter
  • First Online:
Surgical Management of Aortic Pathology

  • 1632 Accesses

Abstract

Aortic stenosis (AS) is an increasingly common problem in developed countries. While surgical aortic valve replacement (SAVR) has long been the gold standard for managing severe, symptomatic AS, there has been a significant shift in the age and complexity of patients requiring intervention, and as a result, an increasing number of patients are not candidates for surgery. Transcatheter aortic valve replacement (TAVR) has developed into a vital alternative for inoperable patients and has shown excellent results in high- and even moderate-risk populations. As the technology has evolved over more than a decade since the first in-human TAVR, the procedure itself has become in many ways routine, has shown excellent safety, and has been adopted by hundreds of hospitals throughout the world. Despite this rapid expansion of TAVR technology, the patient population remains very complex, and individuals frequently have significant comorbid conditions that make TAVR anything but routine. Therefore, the goal of this chapter is to discuss the management of especially high-risk or atypical patients requiring TAVR, how to approach uncommon anatomy or comorbid conditions, and the management of unusual procedural complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Iung B, Cachier A, Baron G, Messika-Zeitoun D, Delahaye F, Tornos P, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005;26:2714–20.

    Article  Google Scholar 

  2. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    Article  CAS  Google Scholar 

  3. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.

    Article  CAS  Google Scholar 

  4. Popma JJ, Adams DH, Reardon MJ, Yakubov SJ, Kleiman NS, Heimansohn D, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J Am Coll Cardiol. 2014;63:1972–81.

    Article  Google Scholar 

  5. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–8.

    Article  CAS  Google Scholar 

  6. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–20.

    Article  CAS  Google Scholar 

  7. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387:2218–25.

    Article  Google Scholar 

  8. Cohen MG, Singh V, Martinez CA, O’Neill BP, Alfonso CE, Martinezclark PO, Heldman AW, O’Neill WW. Transseptal antegrade transcatheter aortic valve replacement for patients with no other access approach - a contemporary experience. Catheter Cardiovasc Interv. 2013;82:987–93.

    Article  Google Scholar 

  9. Greenbaum AB, O’Neill WW, Paone G, Guerrero ME, Wyman JF, Cooper RL, Lederman RJ. Caval-aortic access to allow transcatheter aortic valve replacement in otherwise ineligible patients: initial human experience. J Am Coll Cardiol. 2014;63:2795–804.

    Article  Google Scholar 

  10. Mylotte D, Sudre A, Teiger E, Obadia JF, Lee M, Spence M, et al. Transcarotid transcatheter aortic valve replacement: feasibility and safety. JACC Cardiovasc Interv. 2016;9:472–80.

    Article  Google Scholar 

  11. Campelo-Parada F, Rodes-Cabau J, Dumont E, Del Trigo M, Regueiro A, Doyle D, et al. A novel transcarotid approach for implantation of balloon-expandable or self-expandable transcatheter aortic valves. Can J Cardiol. 2016;32:1575.

    Article  Google Scholar 

  12. Pasic M, Unbehaun A, Buz S, Drews T, Hetzer R. Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv. 2015;8:1–9.

    Article  Google Scholar 

  13. Khatri PJ, Webb JG, Rodes-Cabau J, Fremes SE, Ruel M, Lau K, Guo H, Wijeysundera HC, Ko DT. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158:35–46.

    Article  Google Scholar 

  14. Athappan G, Patvardhan E, Tuzcu EM, Svensson LG, Lemos PA, Fraccaro C, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61:1585–95.

    Article  Google Scholar 

  15. Tamburino C, Capodanno D, Ramondo A, Petronio AS, Ettori F, Santoro G, et al. Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011;123:299–308.

    Article  Google Scholar 

  16. Jones BM, Tuzcu EM, Krishnaswamy A, Popovic Z, Mick S, Roselli EE, et al. Prognostic significance of mild aortic regurgitation in predicting mortality after transcatheter aortic valve replacement. J Thorac Cardiovasc Surg. 2016;152:783–90.

    Article  Google Scholar 

  17. Okuyama K, Jilaihawi H, Kashif M, Soni V, Matsumoto T, Yeow WL, et al. Percutaneous paravalvular leak closure for balloon-expandable transcatheter aortic valve replacement: a comparison with surgical aortic valve replacement paravalvular leak closure. J Invasive Cardiol. 2015;27:284–90.

    PubMed  Google Scholar 

  18. Dhoble A, Chakravarty T, Nakamura M, Abramowitz Y, Tank R, Mihara H, et al. Outcome of paravalvular leak repair after transcatheter aortic valve replacement with a balloon-expandable prosthesis. Catheter Cardiovasc Interv. 2016;89:462–8.

    Article  Google Scholar 

  19. Jones BM, Krishnaswamy A, Kapadia SR. Should embolic protection become the standard of care for stroke prevention during tavi? Rev Esp Cardiol (Engl Ed). 2016;69:890–3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interventional Cardiology, Providence Valve Center, Portland, OR, USA

    Brandon M. Jones

  2. Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Lars G. Svensson

  3. Sones Cardiac Catheterization Laboratory, Interventional Cardiology, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    Samir R. Kapadia

Authors
  1. Brandon M. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars G. Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samir R. Kapadia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samir R. Kapadia .

Editor information

Editors and Affiliations

  1. Fmr Royal Brompton Hospital, London, UK

    Olaf H. Stanger

  2. Royal Brompton Hospital, London, UK

    John R. Pepper

  3. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Lars G. Svensson

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer-Verlag GmbH Austria, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jones, B.M., Svensson, L.G., Kapadia, S.R. (2019). Transcatheter Aortic Valve Replacement: Management of High-Risk Patients and Complex Procedures. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_57

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-4874-7_57

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4872-3

  • Online ISBN: 978-3-7091-4874-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation