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von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement Ascending Aortic Length and Risk of Aortic Adverse Events: The Neglected Dimension Cardiac surgery following transcatheter aortic valve replacement Impact of Incomplete Coronary Revascularization on Late Ischemic and Bleeding Events after Transcatheter Aortic Valve Replacement Impact of Pre-Existing and New-Onset Atrial Fibrillation on Outcomes After Transcatheter Aortic Valve Replacement Coronary Protection to Prevent Coronary Obstruction During TAVR: A Multicenter International Registry Change in Kidney Function and 2-Year Mortality After Transcatheter Aortic Valve Replacement A Controlled Trial of Rivaroxaban After Transcatheter Aortic-Valve Replacement Coronary Access After TAVR With a Self-Expanding Bioprosthesis: Insights From Computed Tomography
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Review ArticleSeptember 9, 2020

JOURNAL：JAMA Cardiol. Article Link

Considerations for Optimal Device Selection in Transcatheter Aortic Valve Replacement: A Review

BE Claessen, GHL Tang, AS Kini et al. Keywords: TAVR; device selection; RCT

ABSTRACT

IMPORTANCE - Aortic valve stenosis (AS) is the most common manifestation of acquired valvular heart disease in developed countries. Several large-scale randomized clinical trials investigating the entire spectrum of patients with severe symptomatic AS from low to prohibitive risk have established transcatheter aortic valve replacement (TAVR) as a safe and effective alternative to surgical aortic valve replacement.


OBSERVATIONS - There are currently only 3 types of TAVR devices commercially available in the US, but several other valve types are undergoing clinical trials in the US. Because of fundamental differences in engineering features, each TAVR device type has specific strengths and limitations. This review aims to provide an overview of design features and clinical outcomes of various TAVR devices that are either commercially available or undergoing clinical investigation.


CONCLUSIONS AND RELEVANCE - Given the lack of large-scale head-to-head comparisons of various TAVR devices and the rapid development of new device iterations, there is insufficient evidence to claim superiority of one device type over another. Nonetheless, as each TAVR device has unique design characteristics, certain patient-related and anatomy-related factors may slightly favor one or several particular designs.

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