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Erschienen in: Herz 6/2017

07.06.2017 | Main topic

Interventional treatment of the aortic valve

Current evidence

verfasst von: F. Jansen, MD, N. Werner, MD

Erschienen in: Herz | Ausgabe 6/2017

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Abstract

Transcatheter aortic valve replacement (TAVR) has become a standard treatment for patients with severe, symptomatic aortic stenosis. Whereas its use was first limited to inoperable high-risk patients, recent studies demonstrated that TAVR was not inferior to standard surgical aortic valve replacement (SAVR) for intermediate-risk patients. Besides equivalent outcomes, the type and rates of complications differ between the two procedures. Here, we provide an overview of the latest randomized study results comparing TAVR with SAVR and describe possible future directions in transcatheter aortic valve treatment.
Literatur
2.
Zurück zum Zitat Cribier A, Eltchaninoff H, Bash A et al (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106:3006–3008CrossRefPubMed Cribier A, Eltchaninoff H, Bash A et al (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106:3006–3008CrossRefPubMed
4.
Zurück zum Zitat Rodés-Cabau J, Webb JG, Cheung A et al (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55:1080–1090. doi:10.1016/j.jacc.2009.12.014 CrossRefPubMed Rodés-Cabau J, Webb JG, Cheung A et al (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55:1080–1090. doi:10.​1016/​j.​jacc.​2009.​12.​014 CrossRefPubMed
6.
Zurück zum Zitat Thomas M, Schymik G, Walther T et al (2010) Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 122:62–69. doi:10.1161/CIRCULATIONAHA.109.907402 CrossRefPubMed Thomas M, Schymik G, Walther T et al (2010) Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: a European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation 122:62–69. doi:10.​1161/​CIRCULATIONAHA.​109.​907402 CrossRefPubMed
7.
Zurück zum Zitat Piazza N, Grube E, Gerckens U et al (2008) Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1‑year following CE mark approval. EuroIntervention 4:242–249CrossRefPubMed Piazza N, Grube E, Gerckens U et al (2008) Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1‑year following CE mark approval. EuroIntervention 4:242–249CrossRefPubMed
11.
Zurück zum Zitat Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. doi:10.1056/NEJMoa1700456 Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med. doi:10.​1056/​NEJMoa1700456
13.
Zurück zum Zitat Kapadia SR, Leon MB, Makkar RR et al (2015) 5‑year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2485–2491. doi:10.1016/S0140-6736(15)60290-2 CrossRefPubMed Kapadia SR, Leon MB, Makkar RR et al (2015) 5‑year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2485–2491. doi:10.​1016/​S0140-6736(15)60290-2 CrossRefPubMed
14.
Zurück zum Zitat Mack MJ, Leon MB, Smith CR et al (2015) 5‑year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2477–2484. doi:10.1016/S0140-6736(15)60308-7 CrossRefPubMed Mack MJ, Leon MB, Smith CR et al (2015) 5‑year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2477–2484. doi:10.​1016/​S0140-6736(15)60308-7 CrossRefPubMed
18.
19.
Zurück zum Zitat Thyregod HGH, Steinbrüchel DA, Ihlemann N et al (2015) 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 65:2184–2194. doi:10.1016/j.jacc.2015.03.014 CrossRefPubMed Thyregod HGH, Steinbrüchel DA, Ihlemann N et al (2015) 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 65:2184–2194. doi:10.​1016/​j.​jacc.​2015.​03.​014 CrossRefPubMed
20.
Zurück zum Zitat Søndergaard L, Steinbrüchel DA, Ihlemann N et al (2016) Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers nordic aortic valve intervention randomized clinical trial. Circ Cardiovasc Interv 9:e003665. doi:10.1161/CIRCINTERVENTIONS.115.003665 CrossRefPubMed Søndergaard L, Steinbrüchel DA, Ihlemann N et al (2016) Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers nordic aortic valve intervention randomized clinical trial. Circ Cardiovasc Interv 9:e003665. doi:10.​1161/​CIRCINTERVENTION​S.​115.​003665 CrossRefPubMed
21.
Zurück zum Zitat Bosmans J, Bleiziffer S, Gerckens U et al (2015) The incidence and predictors of early- and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients. J Am Coll Cardiol 66:209–217. doi:10.1016/j.jacc.2015.05.025 CrossRefPubMed Bosmans J, Bleiziffer S, Gerckens U et al (2015) The incidence and predictors of early- and mid-term clinically relevant neurological events after transcatheter aortic valve replacement in real-world patients. J Am Coll Cardiol 66:209–217. doi:10.​1016/​j.​jacc.​2015.​05.​025 CrossRefPubMed
24.
Zurück zum Zitat Haussig S, Mangner N, Dwyer MG et al (2016) Effect of a cerebral protection device on brain lesions following transcatheter aortic valve implantation in patients with severe aortic stenosis: the CLEAN-TAVI randomized clinical trial. JAMA 316:592–601. doi:10.1001/jama.2016.10302 CrossRefPubMed Haussig S, Mangner N, Dwyer MG et al (2016) Effect of a cerebral protection device on brain lesions following transcatheter aortic valve implantation in patients with severe aortic stenosis: the CLEAN-TAVI randomized clinical trial. JAMA 316:592–601. doi:10.​1001/​jama.​2016.​10302 CrossRefPubMed
25.
Zurück zum Zitat Van Mieghem NM, van Gils L, Ahmad H et al (2016) Filter-based cerebral embolic protection with transcatheter aortic valve implantation: the randomised MISTRAL-C trial. EuroIntervention 12:499–507. doi:10.4244/EIJV12I4A84 CrossRefPubMed Van Mieghem NM, van Gils L, Ahmad H et al (2016) Filter-based cerebral embolic protection with transcatheter aortic valve implantation: the randomised MISTRAL-C trial. EuroIntervention 12:499–507. doi:10.​4244/​EIJV12I4A84 CrossRefPubMed
26.
Zurück zum Zitat Lansky AJ, Schofer J, Tchetche D et al (2015) A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial. Eur Heart J 36:2070–2078. doi:10.1093/eurheartj/ehv191 CrossRefPubMed Lansky AJ, Schofer J, Tchetche D et al (2015) A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial. Eur Heart J 36:2070–2078. doi:10.​1093/​eurheartj/​ehv191 CrossRefPubMed
27.
Zurück zum Zitat Lip GYH, Windecker S, Huber K et al (2014) Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 35(45):3155–3179CrossRefPubMed Lip GYH, Windecker S, Huber K et al (2014) Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 35(45):3155–3179CrossRefPubMed
28.
Zurück zum Zitat Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ et al (2016) Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 9:1706–1717. doi:10.1016/j.jcin.2016.06.025 CrossRefPubMed Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ et al (2016) Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 9:1706–1717. doi:10.​1016/​j.​jcin.​2016.​06.​025 CrossRefPubMed
30.
Zurück zum Zitat Nazif TM, Dizon JM, Hahn RT et al (2015) Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv 8:60–69. doi:10.1016/j.jcin.2014.07.022 CrossRefPubMed Nazif TM, Dizon JM, Hahn RT et al (2015) Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv 8:60–69. doi:10.​1016/​j.​jcin.​2014.​07.​022 CrossRefPubMed
31.
Zurück zum Zitat Urena M, Mok M, Serra V et al (2012) Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol 60:1743–1752. doi:10.1016/j.jacc.2012.07.035 CrossRefPubMed Urena M, Mok M, Serra V et al (2012) Predictive factors and long-term clinical consequences of persistent left bundle branch block following transcatheter aortic valve implantation with a balloon-expandable valve. J Am Coll Cardiol 60:1743–1752. doi:10.​1016/​j.​jacc.​2012.​07.​035 CrossRefPubMed
32.
Zurück zum Zitat Urena M, Hayek S, Cheema AN et al (2015) Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement. Circulation 131:469–477. doi:10.1161/CIRCULATIONAHA.114.011929 CrossRefPubMed Urena M, Hayek S, Cheema AN et al (2015) Arrhythmia burden in elderly patients with severe aortic stenosis as determined by continuous electrocardiographic recording: toward a better understanding of arrhythmic events after transcatheter aortic valve replacement. Circulation 131:469–477. doi:10.​1161/​CIRCULATIONAHA.​114.​011929 CrossRefPubMed
33.
34.
Zurück zum Zitat Ribeiro HB, Webb JG, Makkar RR et al (2013) Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 62:1552–1562. doi:10.1016/j.jacc.2013.07.040 CrossRefPubMed Ribeiro HB, Webb JG, Makkar RR et al (2013) Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol 62:1552–1562. doi:10.​1016/​j.​jacc.​2013.​07.​040 CrossRefPubMed
Metadaten
Titel
Interventional treatment of the aortic valve
Current evidence
verfasst von
F. Jansen, MD
N. Werner, MD
Publikationsdatum
07.06.2017
Verlag
Springer Medizin
Erschienen in
Herz / Ausgabe 6/2017
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI
https://doi.org/10.1007/s00059-017-4585-y

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