As the market for transcatheter aortic valve implantation (TAVI) devices expands, optimisation of implantation techniques and innovation is equally necessary.
An editorial published in the Expert Review of Cardiovascular Therapy journal in June 2022 argues that though the market currently offers a wide choice of self-expanding (SE) devices, matching the best device to each patient is the main goal to compete with balloon-expanding (BE) ones.
The article titled “Expanding our horizons for the use of transcatheter self-expanding valves: what does the future hold?” says that since TAVI indications are expanding, further implementation is needed.
TAVI represents a dynamic, constantly evolving field of interest for interventional cardiology. Despite few head-to-head comparisons and evidence coming from metanalysis and retrospective studies, BE TAVI devices have been always considered superior to SE ones thanks to quicker procedural times, lower incidence of acute kidney injury, lower rate of PPI and less significant PVL that all translate into shorter hospital stays and improved long-term outcomes.
It also adds: “Nevertheless, in the era of tailored medicine, is it inconceivable not to have an alternative? For this purpose, SE valves proved to be even superior to BE ones in specific settings. Accordingly, all catheterisation laboratories should be definitively equipped with both BE and SE devices to offer the best treatment for each patient.”
However, some issues related to the use of SE devices still need to be addressed and further implementation aims to parallel expanding indications to TAVI, it adds.
According to the article, some niche indications of TAVI, such as aortic valve disease in bicuspid morphology, have not found yet the ideal device. “Optimisation of existing platforms and implantation techniques are already in progress, but unmet needs are still waiting for strikingly new innovative technologies,” it concludes.
Dr. Ahmad Edris, Interventional Cardiologist at Cleveland Clinic Abu Dhabi’s Heart, Vascular and Thoracic Institute, says that transcatheter aortic valve replacement (TAVR) has become an important and dominant treatment option for a significant number of patients with symptomatic, severe aortic valve stenosis.
“There have been extensive device developments and procedural improvements since the initial landmark trials, making TAVR a safer and more effective therapy. The referenced article and editorial, highlight several important aspects of programmes treating patients with aortic stenosis. However, an understanding and experience of both balloon-expandable and self-expanding valves are required to treat the full spectrum of patients with anatomical variation and risk,” explains Dr. Edris.
He says that the editorial highlights important strengths and weaknesses of the available devices, and how manufacturers have worked on device development to solve the limitations.
“Our programme utilises a balloon-expandable valve in the majority of our aortic stenosis patients, however, there are a significant number of patients that are better treated with a self-expanding valve. We make this decision after thoroughly reviewing the clinical and anatomic risk of each patient, using CT cardiac imaging,” adds the doctor.
“For example, we have found that in the UAE, patients have smaller aortic valve annulus measurements, compared to our experience in the US. We therefore often use self-expanding valves in this population to achieve better haemodynamic results given the supra-annular design of self-expanding valves. As highlighted in the editorial, we also see an advantage for self-expanding valves in degenerated surgical aortic valve bioprosthesis again, for the hemodynamic advantage.”
He also adds that the future of medicine is in tailoring and individualising each treatment for each patient. “The future is incredibly bright for this technology. I only see an expansion of its use with time as we continue to learn from our experience,” he adds.