We spoke with Azeem Latib, MD, section head and director of interventional cardiology and director of structural heart interventions for Montefiore Health System. Latib also served as a program director for the 2022 Transcatheter Valve Therapeutics (TVT) Structural Heart Summit.
In our chat, he summarized the key advances in transcatheter aortic valve replacements (TAVR) therapy and explained a key TAVR trend that came out of TVT for "lifetime patient management."
It was clear at the meeting that the standard-of-care thinking on TAVR replacements has shifted from just getting a valve implanted and managing immediate complications to looking decades down the road and considering next steps with that same patient. TAVR now makes up about 70% or more of the procedure volume for aortic valve replacements. Latib said the focus of many sessions at TVT was on the longer-term management of valve patients since it is clear TAVR is becoming the standard of care. If a patient gets surgical or TAVR valve today, they will likely need a replacement in 10-20 years. More times than not, Latib explained, this replacement will come in the form of another TAVR valve deployed inside the first valve.
Latib said several sessions discussed what strategy is best, with many experts favoring surgical valve replacement first and two TAVR procedures later in life to eliminate the need for open heart surgery when the patient is much older and more frail. However, many experts admitted this might not be the strategy that gets adopted as a practical standard of care because most patients want the less invasive option versus surgery.
"I think all the companies have realized that they need to move their technologies in that direction," Latib explained. "The bar has been set really high and so we are going to see a lot of new technologies or iterations of technology."
The Edwards Lifesciences Sapien X4, the forth generation of the Sapien valve, is about to start the ALLIANCE pivotal trial. It is designed specifically for lower-risk patients with a lower frame height for better coronary access and it is the first balloon-expandable valve that allows the operator to turn the valve to align the commissures, which also will aid further coronary access. The valve is also designed to reduce the need to use oversized valves to ensure a good fit in the anatomy
"What this means is when you do the next valve you are not going to have issues with coronary access and having a more physiologically aligned valve on the commissures made help the valve last longer," Latib said.
He said the Abbott Portico and Boston Scientific Acurate Neo2 TAVR systems are also undergoing revisions to make them more user friendly and compatible with the shifting needs of TAVR.
Related TAVR Content:
VIDEO: What is needed to build a structural heart program — Interview with Charles Davidson, MD
TAVR's success has changed how cardiologists and surgeons view aortic valve replacement
Cardiac surgeons gaining procedural volume despite TAVR making up 84% of cases
VIDEO: TAVR durability outperforms surgical valves — Interview with Michael Reardon, MD
How the continued rise of TAVR has impacted SAVR outcomes
Left bundle branch block after TAVR hurts outcomes, even when no permanent pacemaker is required
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com