Update on transcatheter aortic valve replacement (TAVR) in the latest 2017 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines for the management of valvular heart disease_West China Medical Journal

Authors：

Thonghong Tasalak , Chopra Manik , De Backer Ole ,  S?ndergaard Lars

The Heart Center, Rigshospitalet University Hospital, Copenhagen, Blegdamsvej 9, 2100 Copenhagen ?, Denmark;

Corresponding?author：

S?ndergaard Lars, Email: drsondergaard@gmail.com

Keywords：

Valvular heart disease; Transcatheter valve therapy; Updates of guideline

DOI：

10.7507/1002-0179.201711089

Video：

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Since the 2012 European Society of Cardiology (ESC)/European Association of Cardio-Thoracic Surgery (EACTS) guidelines on the management of valvular heart disease, a large amount of new data have accumulated. The new evidence has led to an update of the ESC/EACTS guidelines for the management of valvular heart disease in order to have consensus among cardiologists and cardiac surgeons. This article aims to give an update and comprehensive overview on the position of transcatheter aortic valve replacement in the latest 2017 ESC/EACTS guidelines for the management of valvular heart disease.

Citation： Thonghong Tasalak, Chopra Manik, De Backer Ole, S?ndergaard Lars. Update on transcatheter aortic valve replacement (TAVR) in the latest 2017 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines for the management of valvular heart disease. West China Medical Journal, 2018, 33(2): 157-165. doi: 10.7507/1002-0179.201711089 Copy

1.	Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly disease prevalence and number of candidates for transcatheter aortic valve replacement: a Meta-Analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
2.	Coffey S, Cox B, prevalence WT, et al. Progression,and risks of aortic valve sclerosis:a systematic review and meta-analysis. J Am Coll Cardiol, 2014, 63(25 Pt A): 2852-2861.
3.	Mylotte D, Osnabrugge R, Windecker S, et al. Transcatheter aortic valve replacement in Europe:adoption trends and factors influencing device utilization. J Am Coll Cardiol, 2013, 62(3): 210-219.
4.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on 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, 2012, 33(19): 2451-2496.
5.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
6.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
8.	Thyregod HG, Steinbrüchel DA, Ihlemann N, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis: 1-year results from the all-comers NOTION: randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
9.	Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 370(19): 1790-1798.
10.	Arora S, Strassle PD, Ramm CJ, et al. Transcatheter versus surgical aortic valve replacement in patients with lower surgical risk scores: a systematic review and meta-analysis of early outcomes. Heart Lung Circ, 2017, 26(8): 840-845.
11.	Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
12.	Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly?, EuroIntervention, 2016, 11(9):1029-1033.
13.	Hawkins RB, Downs EA, Johnston LE, et al. Impact of transcatheter technology on surgical aortic valve replacement volume, outcomes, and cost. Ann Thorac Surg, 2017, 103(6): 1815-1823.
14.	Vavuranakis M, Siasos G, Zografos T, et al. Dual or single antiplatelet therapy after transcatheter aortic valve implantation? A systematic review and meta-analysis. Curr Pharm Des, 2016, 22(29): 4596-4603.
15.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease: the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2017, 38: 2739-2786.
16.	Iung B, Laouénan C, Himbert D, et al. Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score. Heart, 2014, 100(13): 1016-1023.
17.	Hansson NC, Thuesen L, Hjortdal VE, et al. Three-dimensional multidetector computed tomography versus conventional 2-dimensional transesophageal echocardiography for annular sizing in transcatheter aortic valve replacement: Influence on postprocedural paravalvular aortic regurgitation. Catheter Cardiovasc Interv, 2013, 82(6): 977-986.
18.	Cueff C, Serfaty JM, Cimadevilla C, et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart, 2011, 97(9): 721-726.
19.	Clavel MA, Messika-Zeitoun D, Pibarot P, et al. The complex Nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol, 2013, 62(24): 2329-2338.
20.	Clavel MA, Pibarot P, Messika-Zeitoun D, et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol, 2014, 64(12): 1202-1213.
21.	Herrmann HC, Pibarot P, Hueter I, et al. Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a Placement of Aortic Transcatheter Valves (PARTNER) trial analysis. Circulation, 2013, 127(23): 2316-2326.
22.	Ozkan A, Hachamovitch R, Kapadia SR, et al. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Circulation, 2013, 128(6): 622-631.
23.	Rafique A, Biner S, Ray I, et al. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol, 2009, 104(7): 972-977.
24.	Maréchaux S, Hachicha Z, Bellouin A, et al. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis. Eur Heart J, 2010, 31(11): 1390-1397.
25.	Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
26.	Siontis GC, Praz F, Pilgrim T, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J, 2016, 37(47): 3503-3512.
27.	Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
28.	Cockburn J, Singh MS, Rafi NH, et al. Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2015, 86(7): 1271-1277.
29.	Assmann P, Kievit P, van der Wulp K, et al. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation. Open Heart, 2016, 3(2): e000478.
30.	Puls M, Sobisiak B, Bleckmann A, et al. Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living. Eurointervention, 2014, 10(5): 609-619.
31.	Green P, Arnold SV, Cohen DJ, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol, 2015, 116(2): 264-269.
32.	Bauer T, Linke A, Sievert H, et al. Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol, 2014, 113(3): 518-521.
33.	Phan K, Wong S, Phan S, et al. Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis--systematic review and meta-analysis. Heart Lung Circ, 2015, 24(7): 649-659.
34.	Mylotte D, Lefevre T, S?ndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
35.	Kalra SS, Firoozi S, Yeh J, et al. Initial experience of a second-generation self-expanding transcatheter aortic valve: the UK & Ireland Evolut R Implanters’Registry. JACC Cardiovasc Interv, 2017, 10(3): 276-282.
36.	Popma JJ, Reardon MJ, Khabbaz K, et al. Early clinical outcomes after transcatheter aortic valve replacement using a novel self-expanding bioprosthesis in patients with severe aortic stenosis who are suboptimal for surgery: results of the Evolut R U.S. Study. JACC Cardiovasc Interv, 2017, 10(3): 268-275.
37.	Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation, 2014, 129(13): 1415-1427.
38.	Sorajja P, Kodali S, Reardon MJ, et al. Outcomes for the commercial use of self-expanding prostheses in transcatheter aortic valve replacement: a report from the STS/ACC TVT Registry. JACC Cardiovasc Interv, 2017, 10(20): 2090-2098.
39.	Tummala R, Banerjee K, Sankaramangalam K, et al. Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: a systematic review and meta-analysis. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27398.
40.	Badheka AO, Patel NJ, Panaich SS, et al. Effect of hospital volume on outcomes of transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(4): 587-594.
41.	Durand E, Borz B, Godin M, et al. Transfemoral aortic valve replacement with the Edwards SAPIEN and Edwards SAPIEN XT prosthesis using exclusively local anesthesia and fluoroscopic guidance: feasibility and 30-day outcomes. JACC Cardiovasc Interv, 2012, 5(5): 461-467.
42.	Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv, 2014, 7(8): 898-904.
43.	Alkhalil A, Lamba H, Deo S, et al. Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27230.
44.	Marcantuono R, Gutsche J, Burke-Julien M, et al. Rationale, development, implementation, and initial results of a fast track protocol for transfemoral transcatheter aortic valve replacement (TAVR). Catheter Cardiovasc Interv, 2015, 85(4): 648-654.
45.	Chakravarty T, S?ndergaard L, Friedman J, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet, 2017, 389(10087): 2383-2392.

1. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly disease prevalence and number of candidates for transcatheter aortic valve replacement: a Meta-Analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
2. Coffey S, Cox B, prevalence WT, et al. Progression,and risks of aortic valve sclerosis:a systematic review and meta-analysis. J Am Coll Cardiol, 2014, 63(25 Pt A): 2852-2861.
3. Mylotte D, Osnabrugge R, Windecker S, et al. Transcatheter aortic valve replacement in Europe:adoption trends and factors influencing device utilization. J Am Coll Cardiol, 2013, 62(3): 210-219.
4. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on 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, 2012, 33(19): 2451-2496.
5. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
6. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
8. Thyregod HG, Steinbrüchel DA, Ihlemann N, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis: 1-year results from the all-comers NOTION: randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
9. Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 370(19): 1790-1798.
10. Arora S, Strassle PD, Ramm CJ, et al. Transcatheter versus surgical aortic valve replacement in patients with lower surgical risk scores: a systematic review and meta-analysis of early outcomes. Heart Lung Circ, 2017, 26(8): 840-845.
11. Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
12. Eggebrecht H, Mehta RH. Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly?, EuroIntervention, 2016, 11(9):1029-1033.
13. Hawkins RB, Downs EA, Johnston LE, et al. Impact of transcatheter technology on surgical aortic valve replacement volume, outcomes, and cost. Ann Thorac Surg, 2017, 103(6): 1815-1823.
14. Vavuranakis M, Siasos G, Zografos T, et al. Dual or single antiplatelet therapy after transcatheter aortic valve implantation? A systematic review and meta-analysis. Curr Pharm Des, 2016, 22(29): 4596-4603.
15. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease: the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J, 2017, 38: 2739-2786.
16. Iung B, Laouénan C, Himbert D, et al. Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score. Heart, 2014, 100(13): 1016-1023.
17. Hansson NC, Thuesen L, Hjortdal VE, et al. Three-dimensional multidetector computed tomography versus conventional 2-dimensional transesophageal echocardiography for annular sizing in transcatheter aortic valve replacement: Influence on postprocedural paravalvular aortic regurgitation. Catheter Cardiovasc Interv, 2013, 82(6): 977-986.
18. Cueff C, Serfaty JM, Cimadevilla C, et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart, 2011, 97(9): 721-726.
19. Clavel MA, Messika-Zeitoun D, Pibarot P, et al. The complex Nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol, 2013, 62(24): 2329-2338.
20. Clavel MA, Pibarot P, Messika-Zeitoun D, et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol, 2014, 64(12): 1202-1213.
21. Herrmann HC, Pibarot P, Hueter I, et al. Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a Placement of Aortic Transcatheter Valves (PARTNER) trial analysis. Circulation, 2013, 127(23): 2316-2326.
22. Ozkan A, Hachamovitch R, Kapadia SR, et al. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Circulation, 2013, 128(6): 622-631.
23. Rafique A, Biner S, Ray I, et al. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol, 2009, 104(7): 972-977.
24. Maréchaux S, Hachicha Z, Bellouin A, et al. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis. Eur Heart J, 2010, 31(11): 1390-1397.
25. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med, 2010, 363(17): 1597-1607.
26. Siontis GC, Praz F, Pilgrim T, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J, 2016, 37(47): 3503-3512.
27. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
28. Cockburn J, Singh MS, Rafi NH, et al. Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2015, 86(7): 1271-1277.
29. Assmann P, Kievit P, van der Wulp K, et al. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation. Open Heart, 2016, 3(2): e000478.
30. Puls M, Sobisiak B, Bleckmann A, et al. Impact of frailty on short- and long-term morbidity and mortality after transcatheter aortic valve implantation: risk assessment by Katz Index of activities of daily living. Eurointervention, 2014, 10(5): 609-619.
31. Green P, Arnold SV, Cohen DJ, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol, 2015, 116(2): 264-269.
32. Bauer T, Linke A, Sievert H, et al. Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry). Am J Cardiol, 2014, 113(3): 518-521.
33. Phan K, Wong S, Phan S, et al. Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve stenosis--systematic review and meta-analysis. Heart Lung Circ, 2015, 24(7): 649-659.
34. Mylotte D, Lefevre T, S?ndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22): 2330-2339.
35. Kalra SS, Firoozi S, Yeh J, et al. Initial experience of a second-generation self-expanding transcatheter aortic valve: the UK & Ireland Evolut R Implanters’Registry. JACC Cardiovasc Interv, 2017, 10(3): 276-282.
36. Popma JJ, Reardon MJ, Khabbaz K, et al. Early clinical outcomes after transcatheter aortic valve replacement using a novel self-expanding bioprosthesis in patients with severe aortic stenosis who are suboptimal for surgery: results of the Evolut R U.S. Study. JACC Cardiovasc Interv, 2017, 10(3): 268-275.
37. Van Belle E, Juthier F, Susen S, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation, 2014, 129(13): 1415-1427.
38. Sorajja P, Kodali S, Reardon MJ, et al. Outcomes for the commercial use of self-expanding prostheses in transcatheter aortic valve replacement: a report from the STS/ACC TVT Registry. JACC Cardiovasc Interv, 2017, 10(20): 2090-2098.
39. Tummala R, Banerjee K, Sankaramangalam K, et al. Clinical and procedural outcomes with the SAPIEN 3 versus the SAPIEN XT prosthetic valves in transcatheter aortic valve replacement: a systematic review and meta-analysis. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27398.
40. Badheka AO, Patel NJ, Panaich SS, et al. Effect of hospital volume on outcomes of transcatheter aortic valve implantation. Am J Cardiol, 2015, 116(4): 587-594.
41. Durand E, Borz B, Godin M, et al. Transfemoral aortic valve replacement with the Edwards SAPIEN and Edwards SAPIEN XT prosthesis using exclusively local anesthesia and fluoroscopic guidance: feasibility and 30-day outcomes. JACC Cardiovasc Interv, 2012, 5(5): 461-467.
42. Babaliaros V, Devireddy C, Lerakis S, et al. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv, 2014, 7(8): 898-904.
43. Alkhalil A, Lamba H, Deo S, et al. Safety of shorter length of hospital stay for patients undergoing minimalist transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2017. doi: 10.1002/ccd.27230.
44. Marcantuono R, Gutsche J, Burke-Julien M, et al. Rationale, development, implementation, and initial results of a fast track protocol for transfemoral transcatheter aortic valve replacement (TAVR). Catheter Cardiovasc Interv, 2015, 85(4): 648-654.
45. Chakravarty T, S?ndergaard L, Friedman J, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet, 2017, 389(10087): 2383-2392.

West China Medical Journal

Update on transcatheter aortic valve replacement (TAVR) in the latest 2017 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines for the management of valvular heart disease

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