Third Generation TAVI Prostheses

Catheter-based aortic valve implantation (TAVI) has been introduced 15 years ago, mainly for the treatment of high-risk or inoperable patients. Meanwhile, several thousands implantations have been done worldwide and last year the number of TAVI procedures exceeded the number of surgical aortic valve replacements in Germany. TAVI prostheses have been developed further and new valves have been generated during this time interval. Meanwhile, third generation TAVI prostheses are on the market and deal with the main problematic issues associated with TAVI valves: paravalvular leakage and necessity of pacemaker implantation. New developments, such as the use of skirts around the stents and special valve design have decreased the incidence of at least moderate paravalvular leakage markedly. In addition, some of the new balloon-expandable as well as self-expanding valve prostheses have decreased the necessity of pacemaker implantations to below 5% (close to the numbers achieved after surgical aortic valve replacement). These new third generation TAVI prostheses will be described in detail.

Currently, there are several studies on the way for the use of TAVI procedures in intermediate and low-risk patients and these studies might expand the usage of TAVI procedures in additional patient populations. Cardiac surgeons should stay involved in this fascinating new era and work together with our cardiology partners at the bedside and at the operating table.