Korean Circ J.  2019 Apr;49(4):283-297. 10.4070/kcj.2019.0044.

Aortic Stenosis and Transcatheter Aortic Valve Implantation: Current Status and Future Directions in Korea

• Kim C
• Hong MK

• KMID: 2441132
• DOI: http://doi.org/10.4070/kcj.2019.0044

Abstract

Transcatheter aortic valve implantation (TAVI) has been accepted as one of primary options for treatment of symptomatic severe aortic stenosis. Although TAVI has been predominantly used for patients at high risk or with old age who were not considered optimal candidates for surgical aortic valve replacement (SAVR), its indication is now expanding toward low risk profile and younger age. Many clinical trials are now ongoing to test the possibility of TAVI for use in patients even with uncharted indications who are not eligible for SAVR in current guidelines but may benefit from valve replacement. Current issues including periprocedural safety, long-term adverse events, hemodynamics and durability associated with TAVI should be also solved for expanding use of TAVI. The review presents current status and future directions of TAVI and discusses perspectives in Korea.

Keyword

Aortic valve stenosis; Transcatheter aortic valve replacement

MeSH Terms

Aortic Valve
Aortic Valve Stenosis*
Hemodynamics
Humans
Korea*
Transcatheter Aortic Valve Replacement*

Figure

• 

  Figure 1 Developments, achievements, and future directions in transcatheter aortic valve implantation. AS = aortic stenosis, CE = Conformite Europeenne, EARLY TAVR = Evaluation of Transcatheter Aortic Valve Replacement Compared to SurveilLance for Patients With AsYmptomatic Severe Aortic Stenosis, EVoLVeD = Early Valve Replacement Guided by Biomarkers of Left Ventricular Decompensation in Asymptomatic Patients with Severe AS, NOTION = Nordic Aortic Valve Intervention Trial, PARTNER = Placement of AoRTic TraNscathetER Valve, RCT = randomized controlled trial, STS-PROM = Society of Thoracic Surgeons Predicted Risk of Mortality, SURTAVI = Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients, TAVI = transcatheter aortic valve implantation, THV = transcatheter heart valve.

• 

  Figure 2 Current status and future expansion of TAVI compared with SAVR. The use of TAVI has rapidly increased for the treatment of severe AS with intermediate or low surgical risk in recent years. While TAVI has been indicated in symptomatic patients who require immediate replacement of a native aortic valve, expanded indications including asymptomatic severe AS, bicuspid AS, valve-in-valve, and moderate AS with left-ventricular dysfunction are under investigation. Dedicated risk stratification for TAVI would provide more accurate prediction of the potential benefits of TAVI, in addition to multidisciplinary discussion by heart team, which has and will have played a key role in decisions regarding the choice of valve replacement. AS = aortic stenosis; LVEF = left ventricular ejection fraction; SAVR = surgical aortic valve replacement; TAVI = transcatheter aortic valve implantation.

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