Implementation innovations needed as the TAVI market grows


As the market for transcatheter aortic valve implantation (TAVI) devices grows, optimization of implantation techniques and innovation are also needed.

An editorial published in the journal Expert Review of Cardiovascular Therapy in June 2022 asserts that although the market currently offers a wide choice of self-expanding (SE) devices, matching the best device to each patient is the primary objective in competing. expandable balloons. (BE).

The article entitled “Expanding our horizons for the use of self-expanding transcatheter valves: what does the future hold for us?” says that as TAVI indications grow, further implementation is needed.

TAVI represents a dynamic and constantly evolving area of ​​interest for interventional cardiology. Despite few direct comparisons and evidence from meta-analyses and retrospective studies, BE TAVI devices have consistently been considered superior to SE devices due to faster procedure times, lower incidence of acute kidney injury, lower PPI rates and lower PVL, all of which translate to shorter hospital stays and better long-term outcomes.

He also adds: “However, in the era of tailor-made medicine, is it inconceivable not to have an alternative? To this end, SE valves have proven to be even superior to BE valves in specific parameters. As a result, all catheterization labs should definitely be equipped with both BE and SE devices to provide the best treatment for each patient.

However, some issues with the use of SE devices still need to be resolved, and further implementation aims to extend the indications to TAVI in parallel, he adds.

According to the article, some niche indications for TAVI, such as bicuspid aortic valve disease, have yet to find the ideal device. “Optimization of existing platforms and implementation techniques is already underway, but unmet needs still await remarkably new innovative technologies,” he concludes.

Dr. Ahmad Edris, interventional cardiologist at the Heart, Vascular and Thoracic Institute at Cleveland Clinic Abu Dhabi, says transcatheter aortic valve replacement (TAVR) has become an important and mainstream treatment option for a significant number of patients with symptomatic and severe aortic valve stenosis.

“Many device developments and procedural improvements have been made since the first landmark trials, making TAVR a safer and more effective therapy. The referenced article and editorial highlight several important aspects of treatment programs for patients with aortic stenosis. However, understanding and experience with balloon-expandable and self-expanding valves is necessary to treat the full spectrum of patients with anatomical variations and risks,” says Dr. Edris.

He says the editorial highlights significant strengths and weaknesses of the devices available, and how manufacturers have worked on the development of the devices to address the limitations.

“Our program uses a balloon expandable valve in the majority of our patients with aortic stenosis, however, a significant number of patients are better treated with a self-expanding valve. We make this decision after carefully considering the clinical and anatomical risk of each patient, using CT cardiac imaging,” adds the doctor.

“For example, we have found that in the United Arab Emirates, patients have smaller aortic valve annulus measurements, compared to our experience in the United States. We therefore often use self-expanding valves in this population to achieve better hemodynamic 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 bioprostheses, for the hemodynamic advantage.

He also adds that the future of medicine lies in the adaptation and individualization of each treatment for each patient. “The future is incredibly bright for this technology. I only see an expansion of its use over time as we continue to learn from our experience,” he adds.


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