Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.01.008
Alberto Bouzas-Mosquera , Cayetana Barbeito-Caamaño , María José Martínez-Sapiña , Susana Otero-Muinelo , José Manuel Vázquez-Rodríguez
Transcatheter aortic valve implantation (TAVI) has been a true revolution in the treatment of severe symptomatic aortic stenosis. Various advances have led to an exponential growth in the number of implants and a progressive reduction in their complication rate. One key factor in the success of TAVI has been the role of non-invasive cardiac imaging techniques in pre-procedural planning and candidate selection. These techniques enable the determination of the type and size of the prosthetic valve to be implanted, prediction of risks, assessment of the suitability of vascular access, procedure monitoring, and post-implant follow-up. This review addresses the role of non-invasive imaging techniques before, during, and after transcatheter aortic valve implantation.
{"title":"Técnicas de imagen no invasiva en el implante de prótesis valvulares aórticas transcatéter","authors":"Alberto Bouzas-Mosquera , Cayetana Barbeito-Caamaño , María José Martínez-Sapiña , Susana Otero-Muinelo , José Manuel Vázquez-Rodríguez","doi":"10.1016/j.circv.2024.01.008","DOIUrl":"10.1016/j.circv.2024.01.008","url":null,"abstract":"<div><div>Transcatheter aortic valve implantation (TAVI) has been a true revolution in the treatment of severe symptomatic aortic stenosis. Various advances have led to an exponential growth in the number of implants and a progressive reduction in their complication rate. One key factor in the success of TAVI has been the role of non-invasive cardiac imaging techniques in pre-procedural planning and candidate selection. These techniques enable the determination of the type and size of the prosthetic valve to be implanted, prediction of risks, assessment of the suitability of vascular access, procedure monitoring, and post-implant follow-up. This review addresses the role of non-invasive imaging techniques before, during, and after transcatheter aortic valve implantation.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 58-64"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2025.02.001
Víctor X. Mosquera
{"title":"La importancia de la formación y participación de los cirujanos cardíacos españoles en las terapias TAVI","authors":"Víctor X. Mosquera","doi":"10.1016/j.circv.2025.02.001","DOIUrl":"10.1016/j.circv.2025.02.001","url":null,"abstract":"","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Page 51"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.01.012
Víctor X. Mosquera
Transcatheter aortic valve implantation (TAVI) has become the primary treatment for symptomatic severe aortic stenosis, particularly in patients over 75 years of age and those at high surgical risk. In the last two decades, the number of TAVI procedures has significantly increased, and this trend is expected to continue. Despite the preference for transfemoral access in TAVI, it is unsuitable for up to 20% of patients due to anatomical contraindications such as inadequate vessel size, heavily calcified iliofemoral vasculature, or extreme vessel tortuosity. This has led to the exploration and development of non-TF TAVI approaches, including intrathoracic and extrathoracic approaches.
The emergence of different access routes for TAVI has not been simultaneous, and the choice between intrathoracic and extrathoracic accesses is multifaceted, influenced by the patient's anatomy, comorbidities, and the expertise of the treating center. The transapical approach, classified as intrathoracic, has been the main non transfemoral alternative for nearly a decade. However, the emergence of extrathoracic accesses, such as the transcarotid and transsubclavian approaches, has broadened the horizons of TAVI, potentially offering better outcomes for specific patient populations.
{"title":"Horizontes expandidos en TAVI: explorando las rutas de acceso no transfemoral para cirujanos cardíacos","authors":"Víctor X. Mosquera","doi":"10.1016/j.circv.2024.01.012","DOIUrl":"10.1016/j.circv.2024.01.012","url":null,"abstract":"<div><div>Transcatheter aortic valve implantation (TAVI) has become the primary treatment for symptomatic severe aortic stenosis, particularly in patients over 75 years of age and those at high surgical risk. In the last two decades, the number of TAVI procedures has significantly increased, and this trend is expected to continue. Despite the preference for transfemoral access in TAVI, it is unsuitable for up to 20% of patients due to anatomical contraindications such as inadequate vessel size, heavily calcified iliofemoral vasculature, or extreme vessel tortuosity. This has led to the exploration and development of non-TF TAVI approaches, including intrathoracic and extrathoracic approaches.</div><div>The emergence of different access routes for TAVI has not been simultaneous, and the choice between intrathoracic and extrathoracic accesses is multifaceted, influenced by the patient's anatomy, comorbidities, and the expertise of the treating center. The transapical approach, classified as intrathoracic, has been the main non transfemoral alternative for nearly a decade. However, the emergence of extrathoracic accesses, such as the transcarotid and transsubclavian approaches, has broadened the horizons of TAVI, potentially offering better outcomes for specific patient populations.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 80-87"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141400261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.04.004
Elio Martín Gutiérrez , Pasquale Maiorano , Laura Castillo Pardo , Blanca Meana Fernández , Belén Ramos Barragán , Javier Gualis Cardona , Mario Castaño Ruiz , José Manuel Martínez Comendador , José Manuel Garrido Jiménez
Background
Transcatheter aortic valve implantation (TAVI) has become the most frequent option for severe aortic stenosis treatment. Patients with severe aortic stenosis may present an increased risk of mortality in the asymptomatic phase. Furthermore, the progression of their heart disease may have prognostic implications. It is proposed to carry out a bibliographic review to assess the benefit of TAVI in this context.
Methods
A systematic search in Pubmed and Cochrane was conducted, identifying comparative studies on surgery and/or TAVI versus conservative management in asymptomatic patients. Thus, an algorithm of better management of patients with severe aortic stenosis would be developed according to the available evidence.
Results
After the selection of papers and elimination of duplicates, 34 studies were full-text analyzed, among which we remark: 6 meta-analyses, 4 reviews, 14 original articles and 4 ongoing clinical trials were identified. Early surgery was unanimously superior to conservative management in terms of survival. In the case of TAVI, two studies demonstrated a better prognosis for asymptomatic patients compared to symptomatic patients when their valve disease was corrected with TAVI, and a sub-analysis of the Evolut Low Risk trial demonstrated superior survival results for TAVI compared to surgery and conservative treatment.
Conclusions
In the absence of a solid evidence, TAVI can be considered a valid treatment alternative for patients with asymptomatic aortic stenosis, although this indication relies on indirect evidence. More research is needed in this field.
{"title":"Best evidence topic: implante valvular aórtico transcatéter en pacientes con estenosis aórtica grave asintomática","authors":"Elio Martín Gutiérrez , Pasquale Maiorano , Laura Castillo Pardo , Blanca Meana Fernández , Belén Ramos Barragán , Javier Gualis Cardona , Mario Castaño Ruiz , José Manuel Martínez Comendador , José Manuel Garrido Jiménez","doi":"10.1016/j.circv.2024.04.004","DOIUrl":"10.1016/j.circv.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve implantation (TAVI) has become the most frequent option for severe aortic stenosis treatment. Patients with severe aortic stenosis may present an increased risk of mortality in the asymptomatic phase. Furthermore, the progression of their heart disease may have prognostic implications. It is proposed to carry out a bibliographic review to assess the benefit of TAVI in this context.</div></div><div><h3>Methods</h3><div>A systematic search in Pubmed and Cochrane was conducted, identifying comparative studies on surgery and/or TAVI versus conservative management in asymptomatic patients. Thus, an algorithm of better management of patients with severe aortic stenosis would be developed according to the available evidence.</div></div><div><h3>Results</h3><div>After the selection of papers and elimination of duplicates, 34 studies were full-text analyzed, among which we remark: 6 meta-analyses, 4 reviews, 14 original articles and 4 ongoing clinical trials were identified. Early surgery was unanimously superior to conservative management in terms of survival. In the case of TAVI, two studies demonstrated a better prognosis for asymptomatic patients compared to symptomatic patients when their valve disease was corrected with TAVI, and a sub-analysis of the Evolut Low Risk trial demonstrated superior survival results for TAVI compared to surgery and conservative treatment.</div></div><div><h3>Conclusions</h3><div>In the absence of a solid evidence, TAVI can be considered a valid treatment alternative for patients with asymptomatic aortic stenosis, although this indication relies on indirect evidence. More research is needed in this field.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 110-116"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.02.013
Pilar Garrido-Martín
Introduction
Degenerative aortic stenosis is the most common valvular pathology in the population over 65 years of age, incidence of 2-7%. Currently, transcatheter aortic valve implantation is a standard therapy in these symptomatic patients. This procedure is associated with relatively high rates of complications, which can be serious. The objective of this work is to provide an update and detailed description of the most important complications of the transcatheter aortic valve procedure in terms of etiology, prevalence, diagnosis, prognosis, prevention and treatment.
Methods
Bibliographic review of current evidence on the most important complications of transcatheter aortic valve implantation, their prevention and resolution.
Results
Rhythm disorders, vascular complications, prosthetic regurgitation, cardiac perforation..., are among others some of the possible complications that appear in 2-10% of cases, and are associated with an increase mortality of up to 2 or 3 times.
Conclusions
Complications of the transcatheter aortic valve procedure are frequent and often serious, so it is essential to know the predisposing factors, prevention and treatment strategies. Careful patient selection, quality infrastructure, training and accreditation, multidisciplinary collaboration are essential for optimal prognosis and a decrease in possible complications.
{"title":"Complicaciones en el implante transcatéter de la válvula aórtica. Prevención, resolución y morbimortalidad asociada","authors":"Pilar Garrido-Martín","doi":"10.1016/j.circv.2024.02.013","DOIUrl":"10.1016/j.circv.2024.02.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Degenerative aortic stenosis is the most common valvular pathology in the population over 65 years of age, incidence of 2-7%. Currently, transcatheter aortic valve implantation is a standard therapy in these symptomatic patients. This procedure is associated with relatively high rates of complications, which can be serious. The objective of this work is to provide an update and detailed description of the most important complications of the transcatheter aortic valve procedure in terms of etiology, prevalence, diagnosis, prognosis, prevention and treatment.</div></div><div><h3>Methods</h3><div>Bibliographic review of current evidence on the most important complications of transcatheter aortic valve implantation, their prevention and resolution.</div></div><div><h3>Results</h3><div>Rhythm disorders, vascular complications, prosthetic regurgitation, cardiac perforation..., are among others some of the possible complications that appear in 2-10% of cases, and are associated with an increase mortality of up to 2 or 3 times.</div></div><div><h3>Conclusions</h3><div>Complications of the transcatheter aortic valve procedure are frequent and often serious, so it is essential to know the predisposing factors, prevention and treatment strategies. Careful patient selection, quality infrastructure, training and accreditation, multidisciplinary collaboration are essential for optimal prognosis and a decrease in possible complications.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 52-57"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140782653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.02.009
Francisco Estévez-Cid , Victor X. Mosquera Rodríguez , Consuelo M. Sisinni Ganly , Carmen Iglesias Gil , Jose J. Cuenca Castillo , Juan J. Legarra Calderón
In recent years, TAVI using the cusp overlap projection, or cups-overlap technique (POC), has been postulated as a new alternative for the higher implantation of self-expanding bioprostheses.
The aim of this review is to describe the POC technique and to analyze the reported experience in comparison with the coplanar or standard technique.
TAVI procedures with self-expanding bioprostheses using the POC technique have been shown to be safe and have been associated with better commissural alignment and a higher prosthetic implantation depth, which leads to lower rates of conduction disorders and permanent pacemaker implantation. However, this technique has been associated with higher radiation doses during the procedure.
{"title":"TAVI: implante coplanar vs overlapping-cusp","authors":"Francisco Estévez-Cid , Victor X. Mosquera Rodríguez , Consuelo M. Sisinni Ganly , Carmen Iglesias Gil , Jose J. Cuenca Castillo , Juan J. Legarra Calderón","doi":"10.1016/j.circv.2024.02.009","DOIUrl":"10.1016/j.circv.2024.02.009","url":null,"abstract":"<div><div>In recent years, TAVI using the cusp overlap projection, or cups-overlap technique (POC), has been postulated as a new alternative for the higher implantation of self-expanding bioprostheses.</div><div>The aim of this review is to describe the POC technique and to analyze the reported experience in comparison with the coplanar or standard technique.</div><div>TAVI procedures with self-expanding bioprostheses using the POC technique have been shown to be safe and have been associated with better commissural alignment and a higher prosthetic implantation depth, which leads to lower rates of conduction disorders and permanent pacemaker implantation. However, this technique has been associated with higher radiation doses during the procedure.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 88-92"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141402237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.02.010
Miguel Ángel Gómez Vidal
The transfemoral implantation technique of a transcatheter Aortic valve (TAVI) is the most widespread of all, and although it is basically the same as the rest of the retrograde transarterial implantation techniques, it has its peculiarities, and practically all devices are adapted to this access, being currently the most used in the world.
Talking about transfemoral TAVI implant with everything that is currently written and protocolized by different authors is a bit repetitive, but in general the current descriptions usually refer to a specific device, adapting it to its specific peculiarities, being the most popular. devices from Medtronic (Corevalve and evolut-pro) and Edwards (Sapiens 3 and ultra).
For this reason, I am going to try to give this document an eminently general and practical nature, trying to provide you with the technical possibilities and tricks that experience has allowed me to know and learn.
{"title":"Implante valvular aórtico transcatéter transfemoral paso a paso","authors":"Miguel Ángel Gómez Vidal","doi":"10.1016/j.circv.2024.02.010","DOIUrl":"10.1016/j.circv.2024.02.010","url":null,"abstract":"<div><div>The transfemoral implantation technique of a transcatheter Aortic valve (TAVI) is the most widespread of all, and although it is basically the same as the rest of the retrograde transarterial implantation techniques, it has its peculiarities, and practically all devices are adapted to this access, being currently the most used in the world.</div><div>Talking about transfemoral TAVI implant with everything that is currently written and protocolized by different authors is a bit repetitive, but in general the current descriptions usually refer to a specific device, adapting it to its specific peculiarities, being the most popular. devices from Medtronic (Corevalve and evolut-pro) and Edwards (Sapiens 3 and ultra).</div><div>For this reason, I am going to try to give this document an eminently general and practical nature, trying to provide you with the technical possibilities and tricks that experience has allowed me to know and learn.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 72-79"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.01.011
Miguel Piñón
Transcatheter aortic valve implantation (TAVI) has experienced an increase in the number of procedures of 50% with its expansion to low risk, over the numbers obtained with high and intermediate risks. Recently, updates have been made public in the follow-up of the main randomized clinical studies (RCTs) in this group of patients. Although the results of these studies have served as a basis for recommending TAVI in elderly patients with intermediate or high risks, there are still several aspects that need to be clarified before expanding, in an indiscriminate or unselected manner to low-risk young patients. This review's aim is to analyze the results available in the published evidence, as well as the most significant variables that can affect their consistency, both in early and long term; for consideration in individualized patient-centered decision making.
{"title":"TAVI frente a cirugía convencional aórtica. ¿Dónde están los límites?","authors":"Miguel Piñón","doi":"10.1016/j.circv.2024.01.011","DOIUrl":"10.1016/j.circv.2024.01.011","url":null,"abstract":"<div><div>Transcatheter aortic valve implantation (TAVI) has experienced an increase in the number of procedures of 50% with its expansion to low risk, over the numbers obtained with high and intermediate risks. Recently, updates have been made public in the follow-up of the main randomized clinical studies (RCTs) in this group of patients. Although the results of these studies have served as a basis for recommending TAVI in elderly patients with intermediate or high risks, there are still several aspects that need to be clarified before expanding, in an indiscriminate or unselected manner to low-risk young patients. This review's aim is to analyze the results available in the published evidence, as well as the most significant variables that can affect their consistency, both in early and long term; for consideration in individualized patient-centered decision making.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 102-109"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.circv.2024.01.009
Omar A. Araji-Tiliani
Angio CT has become an essential tool for choosing the size and type of prosthesis to use, as well as the best approach, for the treatment of severe transcatheter aortic stenosis (TAVI).
In this article we describe the important points that must be considered for the correct planning and execution of this technique, with the use of angio CT.
{"title":"La importancia de la planificación en el tratamiento transcatéter de la estenosis aórtica severa","authors":"Omar A. Araji-Tiliani","doi":"10.1016/j.circv.2024.01.009","DOIUrl":"10.1016/j.circv.2024.01.009","url":null,"abstract":"<div><div>Angio CT has become an essential tool for choosing the size and type of prosthesis to use, as well as the best approach, for the treatment of severe transcatheter aortic stenosis (TAVI).</div><div>In this article we describe the important points that must be considered for the correct planning and execution of this technique, with the use of angio CT.</div></div>","PeriodicalId":42671,"journal":{"name":"Cirugia Cardiovascular","volume":"32 2","pages":"Pages 65-71"},"PeriodicalIF":0.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140277465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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