Catheter-Based Therapies: Current Practices and Considerations

*Sidra R. Shah, Hafez Golzarian and Sandeep M. Patel*

### **Abstract**

In just over a decade, there have been paradigm shifts globally in the catheter-based therapies available for the management of patients with severe aortic stenosis. The use of transcatheter aortic valve replacement (TAVR) has been a crucial turning point in the field of cardiology as it granted an option for a minimally invasive method to replace a valve for patients who may or may not be suitable for cardiac surgery. In this chapter, we discuss the current practices and considerations as well as the ongoing evolution of catheter-based approaches for TAVR. The predominant focus of the chapter will be on aortic valve device modifications, prototypes of valves, device delivery systems, and the various techniques. However, discussions on indications/contraindications, proper work-up, preparation, equipment and personnel, complications, and post-procedural management & surveillance will also be reviewed.

**Keywords:** aortic stenosis (AS), transcatheter aortic valve implantation (TAVI), transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR), percutaneous, transcatheter

#### **1. Introduction**

Aortic valve stenosis is a common valvular disease that occurs due to narrowing and stiffening of the valve which restricts blood flow in the body. It is a systolic murmur heard loudest at the 2nd intercostal space in the right upper sternal border. The murmur radiates to the carotids and is described as crescendo-decrescendo. Some causes of the narrowing include calcification of the valve due to aging, congenital valve abnormalities, and rheumatic heart disease. Most people with aortic stenosis can be asymptomatic for years before developing worsening symptoms such as shortness of breath, syncope, fatigue, palpitations, and/or angina. The valve can be repaired or replaced with different procedures depending on the patient's condition. Valve replacement is done by aortic valve replacement surgery or transcatheter aortic valve replacement (TAVR). TAVR is a minimally invasive procedure that replaces the aortic valve in patients who are not candidates for surgery. This procedure has significantly evolved over the years and has become part of the standard of care to improve patient outcomes in aortic stenosis.
