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Archives of cardiovascular diseases
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 27 février 2020
Doi : 10.1016/j.acvd.2019.11.007
Received : 18 June 2019 ;  accepted : 19 November 2019
Durability of transcatheter aortic valve implantation: A translational review
Durabilité des valves aortiques percutanées : une revue translationnelle
 

Charles Fauvel a, Romain Capoulade b, Eric Durand a, c, Delphine M. Béziau d, Jean-Jacques Schott b, Thierry Le Tourneau b, Hélène Eltchaninoff a, c,
a Department of Cardiology, Rouen University Hospital, FHU REMOD-VHF, 76000 Rouen, France 
b L’institut du Thorax, INSERM 1087, CNRS, CHU de Nantes, Université de Nantes, 44007 Nantes, France 
c Normandie université, UNIROUEN, INSERM U1096, 76000 Rouen, France 
d Normandie Université, UNIROUEN, INSERM U1096, Rouen University Hospital, Department of Cardiology, FHU REMOD-VHF, 76000 Rouen, France 

Corresponding author at: Department of Cardiology, Charles-Nicolle Hospital, 1, rue de Germont, 76000 Rouen, France.Department of Cardiology, Charles-Nicolle Hospital1, rue de GermontRouen76000France
Graphical abstract

Central illustration. Transcatheter aortic valve implantation: deterioration biomarkers, pathophysiology and data durability. BVT: bioprosthetic valve thrombosis; 18FDG: 18F-fluorodeoxyglucose; HOMA index: homeostatic model assessment of insulin resistance; Lp(a): lipoprotein(a); MDCT: multidetector computed tomography; PCSK9: proprotein convertase subtilisin/kexin type 9; PET-CT: positron emission tomography; computed tomography; SVD: structural valve deterioration; TAVI: transcatheter aortic valve implantation; TTE: transthoracic echocardiography; y: years.

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Summary

Until recently, transcatheter aortic valve implantation was restricted to high-risk and inoperable patients. The updated 2017 European Society of Cardiology Guidelines has widened the indication to include intermediate-risk patients, based on two recently published trials (PARTNER 2 and SURTAVI). Moreover, two other recent trials (PARTNER 3 and EVOLUT LOW RISK) have demonstrated similar results with transcatheter aortic valve implantation in low-risk patients. Thus, extension of transcatheter aortic valve implantation to younger patients, who are currently treated by surgical aortic valve replacement, raises the crucial question of bioprosthesis durability. In this translational review, we propose to produce a state-of-the-art overview of the durability of transcatheter aortic valve implantation by integrating knowledge of the basic science of bioprosthesis degeneration (pathophysiology and biomarkers). After summarising the new definition of structural valve deterioration, we will present what is known about the pathophysiology of aortic stenosis and bioprosthesis degeneration. Next, we will consider how to identify a population at risk of early degeneration, and how basic science with the help of biomarkers could identify and predict structural valve deterioration. Finally, we will present data on the differences in durability of transcatheter aortic valve implantation compared with surgical aortic valve replacement.

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Résumé

Jusque récemment, l’implantation d’une valve aortique par voie percutanée (TAVI) était réservée aux patients inopérables ou à haut risque chirurgical. En 2017, suite à la parution de deux essais cliniques (PARTNER 2 et SURTAVI), la Société européenne de cardiologie a mis à jour les recommandations et élargi l’indication du TAVI aux patients à risque intermédiaire. Plus récemment, deux autres études (PARTNER 3 et EVOLUT LOW RISK) ont démontré des résultats similaires chez les patients à bas risque. Ainsi, l’extension du TAVI à de jeunes patients, jusqu’alors traités par voie chirurgicale pose la question cruciale de la durabilité des bioprothèses aortiques percutanées. Dans cette revue translationnelle, nous proposons un état de l’art en terme de durabilité du TAVI tout en intégrant les découvertes réalisées en science fondamentale sur la dégénérescence des bioprothèses (physiopathologie et biomarqueurs). Après un rappel concernant les nouvelles définitions des détériorations valvulaires structurelles, les données actuelles en termes de physiopathologie du rétrécissement aortique seront présentées ainsi que celles concernant les facteurs de risque de dégénérescence. Ensuite, la durabilité du TAVI sera comparée à celles des bioprothèses aortiques chirurgicales.

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Keywords : TAVI, Durability, Aortic stenosis, Biomarkers, Structural valve deterioration

Mots clés : TAVI, Durabilité, Rétrécissement aortique, Biomarqueurs, Détérioration valvulaire structurelle

Abbreviations : AS, BVD, BVF, BVT, CI, EAPCI, PCSK9, SAVR, SVD, TAVI, THV




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