Management of patients with transcatheter implantable aortic valve

Valvular heart disease remains one of the causes of cardiovascular morbidity and mortality worldwide. Aortic stenosis is the most common valvular pathology requiring cardiac surgery. For elderly and senile patients with high risks of volumetric cardiac surgery, a new type of biological prosthesis, a transcatheter implantable aortic valve, has become a solution to the problem. Over the past decade catheter interventions for severe valvular heart disease have evolved from balloon dilatation of native stenotic valves to replacement and reconstructive intervention of diseased valves. Transcatheter aortic valve implantation, which is widespread in the USA and Europe, has also begun to be performed in our country, primarily in comorbid groups of patients. Rapid technological advances in device design are likely to improve immediate and long-term outcomes of surgery and expand the current indications for transcatheter aortic valve implantation. The article analyzes the indications for the procedure in accordance with the latest recommendations of 2021, possible complications of the transcatheter aortic valve implantation, as well as the principles of patient management after the procedure, including the principles of drug therapy in this group of patients. Separately, the topic of aortic regurgitation and the possibility of transcatheter aortic valve implantation are touched upon, since this pathology is a new indication that has appeared only in the latest recommendations of the European Society of Cardiology. In this review, we want to acquaint physicians with the indications for transcatheter aortic valve implantation, the main complications, and the principles of managing patients in the perioperative period. The complication rate after transcatheter aortic valve implantation is decreasing due to technical advances and experience of interventional surgeons. In-depth knowledge of potential complications and their prevention plays a key role in improving the immediate and long-term results of surgery.

1. Cardiology: National guidelines. Ed. by E.V. Shlyakhto. 2nd ed., rev. and suppl. M.: GEOTAR-Media, 2020. Рр. 534–48.

2. Vahanian A., Beyersdorf F., Praz F. et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2022;43(7):561–632. DOI: 10.1093/eurheartj ehab395

3. Franzone A., Pilgrim T., Stortecky S., Windecker S. Evolving indications for transcatheter aortic valve interventions. Curr Cardiol Rep 2017;19(11):107. DOI: 10.1007/s11886-017-0921-3

4. Baumgartner H., Hung J., Bermejo J. et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017;18(3):254–5. DOI:10.1093/ehjci/jew335

5. Nanditha S., Malik V., Hasija S. et al. Comparison of grading of aortic stenosis between transthoracic and transesophageal echocardiography in adult patients undergoing elective aortic valve replacement surgeries: a prospective observational study. Ann Card Anaesth 2019;22(2):194–8. DOI: 10.4103/aca.ACA_4_18

6. Reents W., Barth S., Griese D.P. et al. Transfemoral versus transapical transcatheter aortic valve implantation: a single-centre experience. Eur J Cardiothorac Surg 2019;55(4):744–50. DOI: 10.1093/ejcts/ezy363

7. Ando T., Takagi H., Grines C.L. Transfemoral, transapical and transcatheter aortic valve implantation and surgical aortic valve replacement: a meta-analysis of direct and adjusted indirect comparisons of early and mid-term deaths. Interact Cardiovasc Thorac Surg 2017;25(3):484–92. DOI: 10.1093/icvts/ivx150

8. Overtchouk P., Modine T. Alternate Access for TAVI: Stay Clear of the Chest. Interv Cardiol 2018;13(3):145–50. DOI: 10.15420/icr.2018.22.1

9. Holmes D.R. Jr., Brennan J.М., Rumsfeld J.S. et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA 2015;313(10):1019–28. DOI:10.1001/jama.2015.1474

10. Teitelbaum M., Kotronias R.A., Sposato L.A. Bagur R. Cerebral Embolic Protection in TAVI: Friend or Foe. Interv Cardiol 2019;14(1):22–5. DOI: 10.15420/icr.2018.32.2

11. Bhushan S., Huang X., Li Y. et al. Transcatheter aortic valve implantation its incidence, diagnosis, clinical implications, prevention, management, and future perspectives: A Review Article. Curr Probl Cardiol 2022;47(10):100957. DOI: 10.1016/j.cpcardiol.2021.100957

12. Erkapic D., De Rosa S., Kelava A. et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: a comprehensive analysis of the literature. J Cardiovasc Electrophysiol 2012;23(4):391–7. DOI:10.1111/j.1540-8167.2011.02211.x

13. Malev E., Murtazalieva P., Karelkina E. et al. Midventricular obstruction and left ventricular remodeling after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2021;22(Suppl_1):i54. DOI:10.1093/ehjci/jeaa356.054

14. Tsuruta H., Hayashida K., Yashima F. et al. Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2018;92(4):E288–98. DOI: 10.1002/ccd.27508

15. Muntané-Carol G., Okoh A.K., Chen C. et al. Ambulatory electrocardiographic monitoring following minimalist transcatheter aortic valve replacement. JACC Cardiovasc Interv 2021;14(24):2711–22. DOI: 10.1016/j.jcin.2021.08.039

16. Saeedi M., Thomas A., Shellock F.G. Evaluation of MRI issues at 3-Tesla for a transcatheter aortic valve replacement (TAVR) bioprosthesis. Magnetic Resonance Imaging 2015;33(4):497–501. DOI: 10.1016/j.mri.2015.01.012

17. Zoghbi W.A., Asch F.M., Bruce C. et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement. J Am Soc Echocardiogr 2019;32(4):431–75. DOI: 10.1016/j.echo.2019.01.003

18. Shariya M.A., Ustyuzhanin D.V., Lepilin P.M. et al. Role of magnetic resonance imaging in patients with aortic stenosis before and after replacement of the valve. Terapevticheskii arkhiv = Therapeutic archive 2020;92(9):70–6. (In Russ.). DOI: 10.26442/00403660.2020.09.000657

19. Chen S., Redfors B., Nazif T. et al. Impact of renin-angiotensin system inhibitors on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis of from the PARTNER 2 trial and registries. Eur Heart J 2020;41(8):943–54. DOI:10.1093/eurheartj/ehz769

20. Otto C.M., Nishimura R.A., Robert O. Bonow et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: executive summary: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. J Am Coll Cardiol 2020;77:450–500. DOI:10.1161/CIR.0000000000000923

21. Huded C.P., Allen K.B., Chhatriwalla A.K. Counterpoint: challenges and limitations of transcatheter aortic valve implantation for aortic regurgitation. Heart 2021;107(24):1942–5. DOI:10.1136/heartjnl-2020-318682