Low-Gradient, Low-Ejection Fraction Aortic Stenosis

Transcatheter aortic valve replacement: current perspectives and future implications

Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has emerged as an attractive treatment strategy for the treatment of patients with severe symptomatic aortic stenosis (AS), particularly those who are inoperable or at high risk for surgical aortic valve replacement. Several multicentre registries and randomised trials have demonstrated the safety and efficacy of this technology in improving the survival as well as functional capacity of patients with AS. Most of the elderly patients with severe AS have multiple non-cardiac comorbidities, which might limit survival and impede the improvement in functional capacity afforded by TAVR. Therefore, optimal patient selection based on precise risk assessment is currently the cornerstone of evaluation of patients for TAVR. Due to the need for a multifaceted approach in patient evaluation, procedural conduct as well as postprocedure management, multidisciplinary heart valve teams have assumed a paramount role in the TAVR process. This review presents the current perspectives in patient selection, risk assessment, procedural considerations and outcomes following TAVR, along with implications for the future.

Patient evaluation and selection for transcatheter aortic valve replacement: the heart team approach

Transcatheter aortic valve replacement (TAVR) has been shown to significantly impact mortality and quality of life in patients with severe aortic stenosis (AS) who are deemed high risk for surgical aortic valve replacement (SAVR). Essential to these outcomes is proper patient selection. The multidisciplinary TAVR heart team was created to provide comprehensive patient evaluation and aid in proper selection. This review with outline the history and components of the heart team, and delineate the team's role in risk and frailty assessment, evaluation of common co-morbidities that impact outcomes, and the complex multi-modality imaging necessary for procedural planning and patient selection. The heart team is critical in determining patient eligibility and benefit and the optimal operative approach for TAVR. The future of structural heart disease will certainly require a team approach, and the TAVR heart team will serve as the successful model.