Tailoring the valve choice to the patient: contemporary choices and their optimal applications

摘要

In recent years, treatment options for patients with severe symptomatic aortic valve stenosis (AS) have expanded significantly. Previously restricted to extreme and high surgical risk profile patients, there is now evidence for the use of transcatheter aortic valve replacement (TAVR) in elderly patients at intermediate and low surgical risk. Along with this expanded patient population comes an expanded set of individual patient characteristics that warrant careful consideration when selecting the optimal transcatheter heart valve (THV) system. The numerous TAVR systems currently available function well in a wide range of patients, but have key differences in vascular access options, insertion profile, delivery system flexibility, treatable annulus range, THV expansion mechanics, leaflet position, likelihood of inducing conduction abnormalities, etc. No single system has outright superior performance characteristics. A detailed understanding of individual THV system strengths and weaknesses is important in optimizing clinical TAVR outcomes.