TAVR Procedure: 5 Key Facts Highlighting Its Journey and Evolution

Understanding the TAVR Procedure: Key Insights into Its Evolution and Benefits

Transcatheter Aortic Valve Replacement (TAVR) has revolutionised the treatment of severe aortic stenosis, offering a less invasive alternative to traditional surgery (SAVR). Initially reserved for patients at prohibitive surgical risk, TAVR has rapidly expanded to include high, intermediate, and even low-risk patients due to its proven safety and efficacy. In this article, we explore the early beginnings of the TAVR procedure, compare it with SAVR, and highlight the wide range of patient profiles now benefiting from this technology, including those with renal failure, bicuspid valves, and failed surgical bioprostheses through Valve-in-Valve TAVR. We also examine the broader impact of TAVR on cardiovascular care and stress the importance of evidence-based decision-making as its use becomes more widespread.

1. Early beginnings of the TAVR procedure

TAVR was initially restricted to patients with severe symptomatic aortic stenosis deemed at prohibitive risk for SAVR (surgery).

2. TAVR versus SAVR

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Almost twice as many TAVR procedures were performed compared to SAVR in the US in 2019 due to its efficacy in high, intermediate and, recently, low surgical-risk patients.

3. TAVR patient profiles

TAVR represents a safe and effective strategy for aortic valve replacement in patients with renal failure, chronic thrombocytopenia, bicuspid aortic valve, rheumatic valve disease, valve-in-valve procedures, and mixed aortic valve disease.

4. Valve-in-Valve TAVR procedure

Valve-in-Valve (⁠ViV) TAVR is now commonly performed in patients with failed surgical bioprosthesis (~7% as per registry data). A large amount of observational data supports the safety and efficacy of ViV TAVR. ViV TAVR has been associated with lower rates of PVL, stroke or PPI but higher residual gradients and higher rates of coronary occlusion.

5. Impact of TAVR on the medical industry

Given its excellent efficacy and safe results, TAVR has pushed the boundaries of invasive management of aortic stenosis.

6. Special considerations

As TAVR becomes more accessible, its use should be driven by clinical need, heart team consensus, and evidence, not convenience or commercial interests. Misuse may harm patients and undermine trust in this incredible technology.