Published: 2018-05-25

Impressive journey of TAVI so far, but miles to go

Rikin Shah, Bhargav Dave


Valve replacement is mandatory for AS patients owing to its progressive nature leading to continuous valve degeneration. However, surgical replacement cannot be opted for majority of patients due to old age and affiliated co-morbidities. Over the recent years, AS treatment in high-risk patient population favors a newer, less-invasive method of transcatheter aortic valve implantation (TAVI). The main objective of this review is to revisit all the relevant aspects of TAVI to treat AS in high-risk patients and to assess its possibility as a first-line treatment approach even for low-risk AS patients. We searched PubMed, Google Scholar, Medline and to identify all the relevant randomized controlled trials (RCTs) assessing the outcomes of TAVI vs. surgical mode of valve replacement. This method is found to be very safe and reproducible in many landmark clinical trials involving high-risk patients, demonstrating superior or, at least, comparable outcomes vs. surgical mode of treatment. This led to a trend of testing TAVI in lower-risk patient population as well to expand its treatment indication profile.


Aortic stenosis, Generation heart valve, Surgical aortic valve replacement (SAVR), Transcatheter aortic valve implantation (TAVI)

Full Text:



Al-Lamee R, Godino C, Colombo A. Transcatheter aortic valve implantation: Current principles of patient and technique selection and future perspectives. Circ Cardiovasc Interv. 2011;4(4):387-95.

Jose J, Manik G, Abdel-Wahab M. Setting up a transcatheter aortic valve implantation program: Indian perspective. Ind Heart J. 2016;68(5):732-6.

Thielmann M, Tsagakis K, El Gabry M, Jakob H, Wendt D. Transcatheter aortic valve implantation (TAVI) in patients with aortic regurgitation. Ann Cardiothorac Surg. 2017;6(5):558-60.

Rodés-Cabau J. Transcatheter aortic valve implantation: Current and future approaches. Nat Rev Cardiol. 2012;9(1):15-29.

Bax JJ, Delgado V, Bapat V, Baumgartner H, Collet JP, Erbel R, et al. Open issues in transcatheter aortic valve implantation. Part 1: Patient selection and treatment strategy for transcatheter aortic valve implantation. Eur Heart J. 2014;35(38):2627-38.

Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: A single center experience. Indian Heart J. 2014;66(3):320-6.

Braxton JH, Rasmussen KS, Shah MS. Transcatheter Aortic Valve Replacement: A Review. Surg Clin North Am. 2017;97(4):899-921.

Otto CM, Kumbhani DJ, Alexander KP, Calhoon JH, Desai MY, Kaul S, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2017;69(10):1313-46.

Bourantas CV, Van Mieghem NM, Farooq V, Soliman OI, Windecker S, Piazza N, et al. Future perspectives in transcatheter aortic valve implantation. Int J Cardiol. 2013;168(1):11-8.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 aha/ACC guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol. 2017;70(2):252-89.

Cocchia R, D’Andrea A, Conte M, Cavallaro M, Riegler L, Citro R, et al. Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach. World J Cardiol. 2017;9(3):212.

Munoz A, Gomez-Doblas JJ. Patient selection for TAVI. E-journal Cardiol Pract. 2016; Available from: -for-tavi.

Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation. 2002;106(24):3006-8.

Paniagua D, Condado JA, Besso J, Vélez M, Burger B, Bibbo S, et al. First human case of retrograde transcatheter implantation of an aortic valve prosthesis. Tex Heart Inst J. 2005;32(3):393-8.

Webb JG, Chandavimol M, Thompson CR, Ricci DR, Carere RG, Munt BI, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation. 2006;113(6):842-50.

Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv. 2008;1(1):74-81.

Fanning JP, Platts DG, Walters DL, Fraser JF. Transcatheter aortic valve implantation (TAVI): Valve design and evolution. Int J Cardiol. 2013;168(3):1822-31.

Kazan R, Cyr S, Hemmerling TM, Lin SJ, Gilardino MS. The Evolution of Surgical Simulation. Plast Reconstr Surg. 2017;139(2):533e-543e.

Tay E. Transcatheter aortic valve implantation emerging as good alternative to surgery for aortic stenosis- present status. 2015;3(1):3-7.

Meredith IT, Walters DL, Dumonteil N, Worthley SG, Tchétché D, Manoharan G, et al. 1-year outcomes with the fully repositionable and retrievable lotus transcatheter aortic replacement valve in 120 high-risk surgical patients with severe aortic stenosis: Results of the REPRISE II study. JACC Cardiovasc Interv. 2016;9(4):376-84.

Lefèvre T, Colombo A, Tchétché D, Latib A, Klugmann S, Fajadet J, et al. Prospective multicenter evaluation of the direct flow medical transcatheter aortic valve system 12-month outcomes of the evaluation of the direct flow medical percutaneous aortic valve 18f system for the treatment of patients with severe aortic stenosis. JACC Cardiovasc Interv. 2016;9(1):68-75.

Kilic T, Yilmaz I. Transcatheter aortic valve implantation : a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis. J Geriatr Cardiol. 2017;14(3):204-17.

Pascual I, Carro A, Avanza P, Hernández-Vaquero D, Díaz R, Rozado J, et al. Vascular approaches for transcatheter aortic valve implantation. J Thorac Dis. 2017;9(S6):S478-87.

Webb JG, Binder RK. Transcatheter aortic valve implantation: The evolution of prostheses, delivery systems and approaches. Arch Cardiovasc Dis. 2012;105(3):153-9.

Bapat V, Khawaja MZ, Attia R, Narayana A, Wilson K, Macgillivray K, et al. Transaortic transcatheter aortic valve implantation using Edwards SAPIEN valve: A novel approach. Catheter Cardiovasc Interv. 2012;79(5):733-40.

Etienne PY, Papadatos S, El Khoury E, Pieters D, Price J, Glineur D. Transaortic transcatheter aortic valve implantation with the Edwards Sapien valve: Feasibility, technical considerations, and clinical advantages. Ann Thorac Surg. 2011;92(2):746-8.

Yousef A, Froeschl M, Hibbert B, Burwash IG, Labinaz M. Transcatheter aortic valve implantation: current and evolving indications. Can J Cardiol. 2016;32(2):266-9.

Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859-73.

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(19):1790-8.

Yousef A, Simard T, Pourdjabbar A, Webb J, So D, Chong AY, et al. Performance of transcatheter aortic valve implantation in patients with bicuspid aortic valve: Systematic review. Int J Cardiol. 2014;176(2):562-4.

Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017;376(14):1321-31.

Herrmann HC, Pibarot P, Hueter I, Gertz ZM, Stewart WJ, Kapadia S, et al. Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: A placement of aortic transcatheter valves (PARTNER) trial analysis. Circulation. 2013;127(23):2316-26.

Hira RS, Vemulapalli S, Li Z, McCabe JM, Rumsfeld JS, Kapadia SR, et al. Trends and outcomes of off-label use of transcatheter aortic valve replacement: Insights from the NCDR STS/ACC TVT registry. JAMA Cardiol. 2017;2(8):846-54.

Puri R, Chamandi C, Rodriguez-Gabella T, Rodés-Cabau J. Future of transcatheter aortic valve implantation-evolving clinical indications. Nat Rev Cardiol. 2018;15(1):57-65.

Thyregod HGH, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65(20):2184-94.

Yes Latest DVIR Long Term PCR.

Franzone A, Piccolo R, Siontis GCM, Lanz J, Stortecky S, Praz F, et al. Transcatheter aortic valve replacement for the treatment of pure native aortic valve regurgitation: a systematic review. JACC Cardiovasc Interv. 2016;9(22):2308-17.

Ali N, Patel PA, Lindsay SJ. Recent developments and controversies in transcatheter aortic valve implantation. Eur J Heart Fail. 2018;1-9.

Dvir D, Webb J, Brecker S, Bleiziffer S, Hildick-Smith D, Colombo A, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: Results from the global valve-in-valve registry. Circulation. 2012;126(19):2335-44.