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Minerva Cardioangiologica 2018 December;66(6):747-61

DOI: 10.23736/S0026-4725.18.04707-2


lingua: Inglese

New-generation devices for transcatheter aortic valve implantation

Laura GATTO 1, 2, Giuseppe BIONDI-ZOCCAI 3, 4 , Enrico ROMAGNOLI 1, 2, Giacomo FRATI 3, 4, Francesco PRATI 1, 2, Arturo GIORDANO 5, 6

1 Division of Cardiology, S. Giovanni Addolorata Hospital, Rome, Italy; 2 Centro Per La Lotta Contro L’Infarto, Rome, Italy; 3 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; 4 Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Isernia, Italy; 5 Cardiovascular Interventional Operative Unit, Presidio Ospedaliero Pineta Grande, Castel Volturno, Caserta, Italy; 6 Operative Unit of Hemodynamics, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Naples, Italy

Transcatheter aortic valve implantation (TAVI) has overcome the pioneering phase and thanks to accrued clinical evidence has become a mainstay alternative to surgical aortic valve replacement (SAVR) in patients at high risk for post-operative complications. Despite these successes, TAVI remains a junior technology facing momentous developments in techniques and devices. Indeed, several new-generation devices for TAVI have become available in the last few years, including Acurate, Allegra, Evolut, Lotus, JenaValve, Portico, and SAPIEN3. Despite the inevitable setbacks, such as the one represented by DirectFlow, these new devices appear associated with comparative benefits, especially for minimal invasiveness, rates of permanent pacemaker implantation, and risk of residual aortic regurgitation. Indeed, no single device appears clearly better than the others, and a tailored and individualized approach should be sought in using these prostheses, taking into account operator and institutional expertise, on top of patient features. Few comparative effectiveness studies are available to date to guide decision making, and thus careful scrutiny is needed even in everyday clinical practice, especially if seeking to expand the current indications of TAVI. Further guidance will however come from long-term follow-up of completed studies and from results of ongoing trials.

KEY WORDS: Aortic valve stenosis - Comparative effectiveness research - Transcatheter aortic valve replacement

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