Emerging technologies in cardiac interventional care  Premium

Discover how recent advancements in cardiovascular medicine, including TAVI and TEER, are revolutionizing heart disease treatment.

In recent years, cardiovascular medicine has seen significant advancements that have transformed how we diagnose and treat heart diseases. Innovations in cardiac interventional care, specifically for structural heart disease and coronary artery disease, are providing less invasive, more effective options for patients. 

Structural heart diseases are conditions affecting the heart’s valves, walls, or chambers. One of the revolutions in aortic valve disease has been Transcatheter Aortic Valve Implantation (TAVI). TAVI, also known as TAVR (Transcatheter Aortic Valve Replacement), has been a groundbreaking development in the treatment of aortic stenosis, a condition where the aortic valve becomes narrowed, obstructing blood flow from the heart to the rest of the body. Traditionally, treatment required open-heart surgery, which posed significant risks, particularly for elderly patients or those with multiple co-morbidities. TAVI is a minimally invasive procedure in which a new valve is inserted through a catheter, usually via the femoral artery in the groin, though other access points can be used as well. This new valve then takes over the function of the old, diseased valve, significantly improving blood flow and reducing symptoms. 

Rapid advancements and refinements in procedural techniques have been made over the years with TAVI. We have now been able to standardise TAVI procedures with tailored approaches based on the patient’s unique anatomy, health status and risk factors, selecting the most suitable valve type and size leading to greater efficacy, early discharge and improved long-term outcomes. 

New-generation TAVI valves feature enhanced sealing and positioning systems enhancing outcomes by reducing complications such as paravalvular leaks and extending the lifespan of the implant. Innovations in imaging technologies, such as 3-D echocardiography and CT imaging, have improved the precision of valve placement. 

Artificial Intelligence (AI) is now being integrated into imaging and navigation systems to assist in planning and executing procedures with higher accuracy. Also, brain protection filters are now available, which are temporarily placed in the arteries leading to the brain, minimising neurological complications. For patients who have already undergone surgical valve replacements and now face deterioration of their bioprosthetic valve, TAVI offers a “valve-in-valve” approach allowing the placement of a new transcatheter valve inside the existing failed bioprosthetic valve, avoiding a repeat open-heart surgery. 

Our experience, clinical trials and real-world studies have consistently demonstrated the efficacy and safety of TAVI with improved survival rates and quality of life, reinforcing its role as a standard of care for aortic stenosis and supporting its expansion to broader patient groups. 

Mitral regurgitation (MR), where the mitral valve fails to close properly, allowing blood to flow backward into the heart, is another common valve disorder. Transcatheter Edge-to-Edge Repair (TEER) has emerged as a key, minimally invasive procedure valuable for patients with MR who are not suitable candidates for open-heart surgery. TEER involves the use of a device (usually Mitraclip) which is delivered via a catheter to “clip” together the leaflets of the mitral valve reducing the backward flow of blood.