TAVI
TAVI (transcatheter AoV implantation) (JAMA 2021;325:2480; Circ 2021;143:e72)
- Valves: balloon-expandable or self-expanding.
- Most commonly deployed retrograde via perc. transfemoral access (best outcomes)
- Peri- & postprocedural complic.: CHB ~15% at 30d, more common if preexisting RBBB (JACC 2020;76:2391); annular rupture or coronary occlusion (both rare); stroke; local vascular; paravalvular leaks
- Postprocedural antithrombotic Rx: ASA 75–100 mg/d superior to DAPT (NEJM 2020;383:1447). In Pts with indication for OAC: OAC alone superior to OAC + P2Y12 (NEJM 2020;382:1696; Circ 2021;143:e72); apixaban & edoxaban appear comparable to warfarin (ATLANTIS, ACC 2021; NEJM 2021;385:2150)
- Outcomes w/ TAVI: In nonoperative Pts (ie, vs. med Rx): ↓ mortality but still ~72% 5 y mortality in TAVI reflective of comorbidities (NEJM 2012;366:1696; Lancet 2015;385:2485). TAVI noninferior to SAVR in terms of risk of death or disabling stroke for high, intermediate, and low surgical risk Pts (NEJM 2014;370:1790; 2020;382:799; 2019;380:1695 & 2019;380:1706; JACC 2021;77:1149).