Transcatheter Valve Replacement for Aortic Stenosis: Balancing Benefits, Risks, and Expectations

Perspective:

The following are five points to remember about transcatheter aortic valve replacement (TAVR):

1. Transcatheter aortic valve replacement (TAVR) represents a transformative technology with potential for the management of complex patients with aortic stenosis, including those who are not considered candidates for surgical aortic valve replacement because of age and medical comorbidities.

2. Stroke remains a major complication following TAVR, both short-term and long-term, likely due to embolism of atherothrombotic debris from the aorta or the native valve.

3. An increasingly recognized complication following TAVR is the development of heart block necessitating permanent pacemaker implantation. There is a much higher risk of heart block (roughly twofold) with the use of the Medtronic CoreValve compared with the Edwards Sapien valve.

4. More recently, paravalvular aortic regurgitation has also arisen as a major determinant of poor postprocedural outcome. Compared with surgical valve replacement, TAVR is associated with more frequent and more severe paravalvular regurgitation.

5. These complications of TAVR underscore the need for further investigation and device development to improve clinical outcomes. They also provide reason for pause in the rush to expand the patient population eligible for TAVR. It is essential that patient and physician expectations be balanced with a realistic assessment of potential benefits, risks, and outcomes to provide the optimal therapy for severe aortic stenosis.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, Cardiac Surgery and Arrhythmias

Keywords: Heart Valve Prosthesis, Surgical Instruments, Stroke, Vomiting, Heart Block, Pacemaker, Artificial, Embolism, Heart Valve Prosthesis Implantation


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