Patient-Tailored Optimization of Transcatheter Aortic Valve Implantation

Abstract

Treatment of aortic valve stenosis with transcatheter aortic valve implantation (TAVI) has evolved tremendously during the last decade. Although a lot of expertise and knowledge over the years is gained, several challenges remain and offer opportunities for further improvement of TAVI. This thesis highlights a few aspects in the wide range of challenges of the TAVI procedure in relation to the growing demand for treatment. Promising results have been achieved, both in terms of the assessment of aortic regurgitation, as well as in improving insights regarding early hospital discharge and patient-tailored TAVI treatment. We demonstrated in a laboratory setting that aortic regurgitation can be measured accurately by magnetic resonance imaging in the presence of a TAVI valve when the appropriate measuring level is used. The applicability of this proposed method was confirmed in a comparative clinical study. We identified clinical predictors for the occurrence of conduction disturbances after TAVI. Thereby, it is feasible to identify a subset of patients in which early discharge may be safe. Cost reduction by reducing hospital stay is possible, but appeared to be limited in absolute amounts. Finally, a variety of options have been explored to further improve clinical outcomes using a patient-tailored approach. Altogether, new insights and answers to relevant clinical questions were provided. It also clearly demonstrates the importance of a patient-tailored approach and of further optimization of the TAVI procedure, to improve clinical outcome of this patient population.