TAVR Year in Review: From the 2024 SCAI Scientific Sessions

In his session “TAVR: Year in Review,” presented at the 2024 SCAI Scientific Sessions,¹ Chad Kliger, MD, FSCAI, discussed the developments in the transcatheter aortic valve replacement (TAVR) field over the past year, with special focus on the newest valves and valve design, advancements in hemodynamics, and lifetime patient management as interventional cardiologists (ICs) navigate this ever-dynamic space.

Dr Kliger began his presentation with the findings that, based on data from 2023 to 2024, the life expectancy of younger (<65-70 years old) TAVR patients is longer. Thus, from a patient’s very first intervention, physicians must always be looking ahead to the potential subsequent procedures. Fortunately, thanks to the myriad advancements in the field, ICs are gaining the information and tools they need to confidently prepare for the lifetime management of their patients.

With the overarching objective of patient care in mind, Dr Kliger introduced several new valves that have entered the IC space over the past year. One notable mention was Boston Scientific’s ACURATE NEO 2, the current iteration of the ACURATE NEO, which is distinguished from its predecessor in the form of a taller outer skirt and radiopaque marker. Though awaiting FDA approval (as of May 14, 2024), the results of available data show favorable outcomes in a TAVI population.² Dr Kliger also spotlighted the JenaValve Trilogy transcatheter heart valve, which features a dedicated aortic regurgitation (AR) platform and demonstrates promising results as a nonsurgical treatment option for patients with native AR.³

Hemodynamics has been another discussion point over the past year as data from the SMART Trial continue to emerge. This prospective study compares the outcomes of self-expanding (SEV) vs balloon-expandable (BEV) TAVR devices, and its powered secondary endpoints include hemodynamic structural valve dysfunction and hemodynamic mean gradient. This trial is notable for its enrollment of primarily female patients with small aortic annuli, a cohort that is historically underrepresented in clinical trials.⁴ As of May 3, 2024, the SEV has proven hemodynamically superior to the BEV in this cohort at all follow-ups up to 1 year.⁵

ICs also saw advancements in artificial intelligence (AI) technologies, particularly in preprocedural planning and simulations. Dr Kliger emphasized the advantages of leveraging AI technologies such as DASI (DASI Simulations), a simulator via which operators can select the ideal valve, its size, and the depth of implant, and, based on these factors, DASI’s AI algorithm can predict potential associated complications. Employing predictive technologies like DASI can help ICs strategize for lifetime management, including the planning of a future second valve, which is especially valuable in light of the risks of valve-in-valve interventions.

Though more technologies and TAVR platforms may now be available to ICs, it does not necessarily mean that they are applicable to each case; it is crucial that operators become knowledgeable about these options not only to be able to use them in their practice but also to understand when they may not fit into a patient’s care plan. While 2023 and 2024 gave us longer-term data on TAVR and SAVR, many trials, such as SMART, are ongoing and operators must be ready to adapt as new data arise and algorithms evolve. As Dr Kliger explains: “As you gain data, your decision tree does change…. with newer technologies in the space, you have to get comfortable and figure out where their home is. [AI] is where we need to be able to go to not only necessarily tell us what to do, but to confirm our game plans and then to optimize our approaches. I think we need to learn from this.”

Dr Kliger’s full presentation can be found at: https://scai.confex.com/scai/2024/meetingapp.cgi/Paper/27081

References

1. Kliger C. TAVR: Year in Review. SCAI Scientific Sessions; May 2-4, 2024; Long Beach, CA. Session 27801.
2. Rück A, Kim WK, Abdel-Wahab M, et al. The Early neo2 Registry: transcatheter aortic valve implantation with ACURATE neo2 in a European population. J Am Heart Assoc. 2023;12(15):e029464. doi: 10.1161/JAHA.122.029464
3. Vahl TP, Thourani VH, Makkar RR, et al. Transcatheter aortic valve implantation in patients with high-risk symptomatic native aortic regurgitation (ALIGN-AR): a prospective, multicentre, single-arm study. Lancet. 2024;403(10435):1451-1459. doi: 10.1016/S0140-6736(23)02806-4
4. Hermann HC, Tchetche D, Mehran R. Self-expanding versus balloon-expandable transcatheter aortic valve replacement in patients with small aortic annuli: additional outcomes from the SMART Trial. JSCAI. 2024;3(5)(suppl):101879. doi: 10.1016/j.jscai.2024.101879
5. Hermann HC. SMART Trial reaffirms hemodynamic superiority of TAVR self-expanding valve in aortic stenosis patients with a small annulus over time and regardless of age. News release. SCAI Scientific Sessions. May 3, 2024. Accessed May 15, 2024. https://scai.org/smart-trial-reaffirms-hemodynamic-superiority-tavr-self-expanding-valve-aortic-stenosis-patients