The Exchange

Commentary and Observations from
the Medical Front Lines

Transcatheter Aortic Valve Replacement: What's In It for Your Patient?

Transcatheter Aortic Valve Replacement: What's In It for Your Patient?

Over the last few years more and more development and technology has been devoted to transcatheter aortic valve replacement, or TAVR. This procedure, developed and used for only those with severe aortic stenosis, is done by either a self-expanding or balloon expanding catheter that places the native or replaced valve leaflets against the aortic root walls, creating a new valve structure. The technology is rapidly improving, and the early success was mixed. Concern still remains on the potential for stroke with this procedure. As the device is deployed by either self-expanding or balloon technique, there is the potential for an embolic event or hypoperfusion to occur that can cause a cerebrovascular accident (CVA). Another risk associated with this procedure is the creation of an embolus on the aortic root wall that has potential to dislodge.

The initial data on these new procedures are not consistent, and questions are raised as to the real number of increased CVAs and lesions that result. In addition, recent studies suggest that in patients who undergo these procedures, there may be a small showering effect of emboli that are silent—without symptoms detected—or transient in nature. In some studies, most of these events appear to have resolved after a 3-month post-procedure time frame. To help counter these potential adverse effects, measures are being taken and used where other devices are employed to attempt to capture any emboli or material that may have the potential to cause a stroke.

All in all, the success levels for this procedure are still noteworthy and a consideration for patients who have severe disease and significant quality-of-life issues. PAs and nurse practitioners who have patients with this condition should consider getting a cardiology evaluation so that patients may get the most up-to-date advice on managing this disease.

References
  • Abdel-Wahab M, Mehilli J, Frerker C, et al. Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. JAMA. 2014;311:1503-1514.
  • Eggebrecht H, Schmermund A, Voigtländer T, Kahlert P, Erbel R, Mehta RH. Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention. 2012;8:129-138.
  • Ghanem A, Müller A, Nähle CP, et al. Risk and fate of cerebral embolism after transfemoral aortic valve implantation: a prospective pilot study with diffusion-weighted magnetic resonance imaging. J Am Coll Cardiol. 2010;55:1427-1432.
  • Kahlert P, Knipp SC, Schlamann M, et al. Silent and apparent cerebral ischemia after percutaneous transfemoral aortic valve implantation: a diffusion-weighted magnetic resonance imaging study. Circulation. 2010;121:870-878.
  • Khatri PJ, Webb JG, Rodés-Cabau J, et al. Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med. 2013;158:35-46.
  • Lansky AJ, Schofer J, Tchetche D, et al. A prospective randomized evaluation of the TriGuard™ HDH embolic DEFLECTion device during transcatheter aortic valve implantation: results from the DEFLECT III trial. Eur Heart J. 2015;36:2070-2078.
  • Van Mieghem NM, El Faquir N, Rahhab Z, et al. Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2015;8:718-724.

Share this page:

Development Widget