Transcatheter Aortic Valve Implantation (TAVI) Using the Transapical Approach

  • Pavel Overtchouk
  • Thomas Modine


After being initially developed in animals, trans-catheter aortic valve implantation or replacement (TAVI or TAVR) was performed for the first time in human by Alain Cribier, interventional cardiologist at Rouen Teaching Hospital via trans-femoral venous approach using trans-septal (through the inter-atrial septum) pathway to implant a percutaneous three bovine pericardial leaflet 23 mm of diameter heart valve, to treat a severe calcified aortic stenosis responsible for a cardiogenic shock in an inoperable patient [1]. Ever since TAVI has been a fast-growing technique of interventional treatment of the most frequent valvulopathy in the elderly patients.


  1. 1.
    Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis. Circulation. 2002;106(24):3006–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Walther T, Möllmann H, van Linden A, Kempfert J. Transcatheter aortic valve implantation transapical: step by step. Semin Thorac Cardiovasc Surg. 2011;23(1):55–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Walther T, Dewey T, Borger MA, Kempfert J, Linke A, Becht R, et al. Transapical aortic valve implantation: step by step. Ann Thorac Surg. 2009;87(1):276–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Walther T, Falk V, Borger MA, Dewey T, Wimmer-Greinecker G, Schuler G, et al. Minimally invasive transapical beating heart aortic valve implantation—proof of concept. Eur J Cardiothorac Surg. 2007;31(1):9–15.CrossRefPubMedGoogle Scholar
  5. 5.
    Albacker T, Ramankutty R, Roselli E. Transapical transcatheter aortic valve implantation [Internet]. CTSNet. 2012.
  6. 6.
    Astarci P, El Khoury G, David G, Kefer J, Renkin J, Vanoverschelde J-L. “Ring Pledget”: a new concept for secure apex closure during transapical aortic valve implantation. Innovations. 2010;5(2):136–7. Scholar
  7. 7.
    Papadopoulos N, El-Sayed Ahmad A, Thudt M, Fichtlscherer S, Meybohm P, Reyher C, et al. Successful fast track protocol implementation for patients undergoing transapical transcatheter aortic valve implantation. J Cardiothorac Surg. 2016;11:55.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Wei L, Liu H, Zhu L, Yang Y, Zheng J, Guo K, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the j-valve and early outcome. JACC Cardiovasc Interv. 2015;8(14):1831–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Edwards SAPIEN 3 transcatheter heart valve [Internet]. Accessed 26 Nov 2016.
  10. 10.
    Transcatheter Aortic Valve Replacement—TAVR|Medtronic Engager [Internet]. Accessed 26 Nov 2016.
  11. 11.
    ACURATE TA|Symetis [Internet]. Accessed 26 Nov 2016.
  12. 12.
    About JenaValve—JENAVALVE [Internet]. Accessed 26 Nov 2016.
  13. 13.
    Roy DA, Schaefer U, Guetta V, Hildick-Smith D, Möllmann H, Dumonteil N, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol. 2013;61(15):1577–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137(5):1258–64.CrossRefPubMedGoogle Scholar
  15. 15.
    Blumenstein J, Kim W-K, Liebetrau C, Gaede L, Kempfert J, Walther T, et al. Challenges of coronary angiography and intervention in patients previously treated by TAVI. Clin Res Cardiol. 2015;104(8):632–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Fusini L, Mirea O, Tamborini G, Muratori M, Gripari P, Cefalù C, et al. Incidence and severity of atherosclerotic cardiovascular artery disease in patients undergoing TAVI. Int J Cardiovasc Imaging. 2015;31(5):975–85.CrossRefPubMedGoogle Scholar
  17. 17.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin I, John P, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(22):e57–185.CrossRefPubMedGoogle Scholar
  18. 18.
    Silaschi M, Conradi L, Seiffert M, Schnabel R, Schön G, Blankenberg S, et al. Predicting risk in transcatheter aortic valve implantation: comparative analysis of EuroSCORE II and established risk stratification tools. Thorac Cardiovasc Surg. 2015;63(06):472–8.PubMedGoogle Scholar
  19. 19.
    Silaschi M, Treede H, Rastan AJ, Baumbach H, Beyersdorf F, Kappert U, et al. The JUPITER registry: 1-year results of transapical aortic valve implantation using a second-generation transcatheter heart valve in patients with aortic stenosis. Eur J Cardiothorac Surg. 2016;50(5):874–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Kempfert J, Holzhey D, Hofmann S, Girdauskas E, Treede H, Schröfel H, et al. First registry results from the newly approved ACURATE TA™ TAVI system. Eur J Cardiothorac Surg. 2015;48(1):137–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Bagur R, Kiaii B, Teefy PJ, Diamantouros P, Lavi R, Harle C, et al. First North American experience with the engager self-expanding transcatheter aortic valve: insights from the London Health Sciences Centre Heart Team. Ann Thorac Surg. 2016 Aug 1;102(2):e167–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Gaede L, Kim W-K, Blumenstein J, Liebetrau C, Dörr O, Nef H, et al. Temporal trends in transcatheter and surgical aortic valve replacement: an analysis of aortic valve replacements in Germany during 2012–2014. Herz. 2016;42(3):316–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Kodali S, Thourani VH, White J, Malaisrie SC, Lim S, Greason KL, et al. Early clinical and echocardiographic outcomes after SAPIEN 3 transcatheter aortic valve replacement in inoperable, high-risk and intermediate-risk patients with aortic stenosis. Eur Heart J. 2016;37(28):2252–62.CrossRefPubMedGoogle Scholar
  24. 24.
    Yamamoto M, Mouillet G, Meguro K, Gilard M, Laskar M, Eltchaninoff H, et al. Clinical results of transcatheter aortic valve implantation in octogenarians and nonagenarians: insights from the FRANCE-2 registry. Ann Thorac Surg. 2014 Jan;97(1):29–36.CrossRefPubMedGoogle Scholar
  25. 25.
    Thourani VH, Jensen HA, Babaliaros V, Kodali SK, Rajeswaran J, Ehrlinger J, et al. Outcomes in nonagenarians undergoing transcatheter aortic valve replacement in the PARTNER-I trial. Ann Thorac Surg. 2015;100(3):785–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Biancari F, D’Errigo P, Rosato S, Pol M, Tamburino C, Ranucci M, et al. Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessel. 2016;1:1–9.Google Scholar
  27. 27.
    Webb J, Gerosa G, Lefèvre T, Leipsic J, Spence M, Thomas M, et al. Multicenter evaluation of a next-generation balloon-expandable transcatheter aortic valve. J Am Coll Cardiol. 2014;64(21):2235–43.CrossRefPubMedGoogle Scholar
  28. 28.
    Baumbach H, Ahad S, Rustenbach C, Hill S, Schäufele T, Wachter K, et al. Conventional versus transapical aortic valve replacement: is it time for shift in indications? Thorac Cardiovasc Surg. 2017;65(3):212–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015;385(9986):2477–84.CrossRefPubMedGoogle Scholar
  30. 30.
    Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.CrossRefPubMedGoogle Scholar
  31. 31.
    Rex CE, Hjortdal VE, Heiberg J, Klaaborg K-E. Health-related quality-of-life after transapical transcatheter aortic valve implantation. Scand Cardiovasc J. 50(5–6):377–82.
  32. 32.
    Nielsen HHM, Klaaborg KE, Nissen H, Terp K, Mortensen PE, Kjeldsen BJ, et al. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. EuroIntervention. 2012;8(3):383–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Thyregod HGH, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65(20):2184–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Siontis GCM, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J. 2016;37(47):3503–12.CrossRefPubMedGoogle Scholar
  36. 36.
    Manoharan G, Walton AS, Brecker SJ, Pasupati S, Blackman DJ, Qiao H, et al. Treatment of symptomatic severe aortic stenosis with a novel resheathable supra-annular self-expanding transcatheter aortic valve system. JACC Cardiovasc Interv. 2015;8(10):1359–67.CrossRefPubMedGoogle Scholar
  37. 37.
    Seiffert M, Bader R, Kappert U, Rastan A, Krapf S, Bleiziffer S, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv. 2014;7(10):1168–74.CrossRefPubMedGoogle Scholar
  38. 38.
    Holzhey D, Linke A, Treede H, Baldus S, Bleiziffer S, Wagner A, et al. Intermediate follow-up results from the multicenter engager European pivotal trial. Ann Thorac Surg. 2013;96(6):2095–100.CrossRefPubMedGoogle Scholar
  39. 39.
    Seiffert M, Conradi L, Kloth B, Koschyk D, Schirmer J, Schnabel RB, et al. Single-centre experience with next-generation devices for transapical aortic valve implantation. Eur J Cardio-Thorac. 2015;47(1):39–45; discussion 45.Google Scholar
  40. 40.
    Mylotte D, Sudre A, Teiger E, Obadia JF, Lee M, Spence M, et al. Transcarotid transcatheter aortic valve replacement: feasibility and safety. JACC Cardiovasc Interv. 2016;9(5):472–80.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pôle de ReanimationHôpital Roger Salengro, Centre Hospitalier et UniversitaireLilleFrance
  2. 2.Centre Hospitalier Régional Universitaire de LilleLilleFrance

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