Transcatheter Aortic Valve Implantation: Tips and Tricks to Avoid Failure PDF

Preface

It is human nature to develop and to evolve, to adapt and to adopt. These features are essential for the safeguarding of our future in an ever changing world. Transcatheter Aortic Valve Implantation (TAVI) is an example of such a development and evolution. Even in the absence of sound clinical data on its safety, efficacy, and durability, it is clear that we have to recognize its presence to which we must adapt and also assume our responsibility to improve TAVI from both a technological and clinical point of view.

This starts by a true understanding of all its components that ranges from an in-depth understanding of patient-related issues such as the anatomy of the aortic root, an in-depth understanding of the technology itself to the fine points of the procedure that not only include all facets of positioning and implantation but also the imaging techniques that are needed for guidance and evaluation, and last but not least, postoperative management of the patient.

The goal of this book is to help readers understand TAVI in its full spectrum and provide readers with the necessary information to perform a safe and successful transcatheter aortic valve implantation procedure. The "tips and tricks" captured in this first edition represent the learning experiences of the pioneers who contributed to the maturation and advancement of the technology. This textbook was written at the time when approximately 6000 transcatheter aortic valve implantation procedures were performed worldwide. Despite this, TAVI still is an experimental treatment since there is still much to learn, to understand, and to improve.

With the use of visual aids (over 200 color figures and 3 hours of DVD material), the authors attempt to explain, in detail, each step of the procedure. The textbook has been divided into three parts: (1) preprocedural, (2) intraprocedural, and (3) postprocedural "tips and tricks."

The initial chapters begin with a detailed description of the anatomy of the aortic valve that is essential to understand correct placement of the device and potential complications associated with the procedure. Also unique is a chapter on post-mortem examinations following transcatheter aortic valve implantation—such information will become crucial to unravel some of the mysteries of the procedure and causes of death in these individuals.

The second part of this book provides the intraprocedural tips and tricks that have been acquired through experience and mistakes and covers vascular access, advancement of the delivery catheter system, device placement and deployment, and acute procedural complications.

The third part of this book is dedicated to the postprocedural care of the patient and tries to address issues such as the length of stay in the intensive care unit, the indication and duration of temporary pacing, complications within the first 48 to 72 hours, antithrombotic/antiplatelet therapy post-implant.

The last section of the book provides a glimpse into the future for upcoming valve designs and ideas. Novel transcatheter aortic valve designs will soon enter the market. These devices will strive for lower profile catheters, durability of the valve prosthesis, and the ability to fully retrieve and/or reposition the device after assessing its function but before complete valve deployment.

There remain many unanswered questions with respect to patient selection (e.g., Should TAVI be restricted to high risk and inoperable patients?), to the selection of the appropriate valve size, and the etiology of complications that may occur (e.g., conduction abnormalities and paravalvular aortic regurgitation).

On behalf of all authors we hope that this book will enrich our understanding of TAVI in all its facets—from patient selection to its execution and postoperative management—and that it may inspire us to join forces in a multidisciplinary approach to thoroughly investigate TAVI from both a biomedical engineering and clinical perspective so that we continue the development with the ultimate goal of helping more patients in an appropriate way.

Special thanks go to Dr. Nicolo Piazza who was the mid-field in this endeavor. Thanks to his skills and detailed acquaintance with TAVI; he made sure that chapters of high quality were submitted in a timely fashion.