Transcatheter Aortic Valve Therapies : Insights and Solutions for Clinical Complications and Future Perspectives

This thesis contemplates current challenges of transcatheter aortic valve implantation (TAVI) and focuses on three important entities.

Conduction disorders remain a frequent issue. Daily ECG analysis after the procedure may help predict the fate of acquired conduction abnormalities at an earlier stage and identify the patients who would benefit from (early) permanent pacemaker implantation.

Access site management relies on suture-based techniques and has inherent limitations. Collagen plug based closure is a different mechanism, may be easier to adopt and globally reduce vascular complications.

Brain injury seems omnipresent after TAVI and is difficult to reconcile with the “primum non nocere” principle. Filter based embolic protection hold promise to mitigate the effects of cerebral embolization, especially if complete protection is achieved.

TAVI has now matured into a simplified procedure under local anesthesia and the performance of the latest transcatheter valve iterations approach or even supersede what can be achieved with a surgical bioprosthesis.

Bicuspid aortic disease, severe aortic regurgitation and moderate aortic stenosis in heart failure are potential new indications for TAVI. Furthermore, TAVI is attractive for treatment in patients at lower risk who are younger and have a longer life expectancy.