Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

• Authors: Muzamil Khawaja, Emory University; Hafeez Ul Hassan Virk, Case Western Reserve University; Dhrubajyoti Bandyopadhyay, New York Medical College; Mario Rodriguez, Washington University in St. Louis; Johao Escobar, Harlem Cardiology, New York; Mahboob Alam, Baylor College of Medicine; Hani Jneid, University of Texas Medical Branch; Chayakrit Krittanawong, NYU School of Medicine
• Journal Title: Journal of Cardiovascular Development and Disease
• Volume: Volume 10, Number 7
• Publisher: MDPI | 2023-07-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/jcdd10070265
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: aortic valve stenosis; TAVR; TAVI

Abstract

Patients with a clinical indication for aortic valve replacement can either undergo surgical aortic valve replacement (SAVR) or Transcatheter Aortic Valve Implantation (TAVI). There are many different factors that go into determining which type of replacement to undergo, including age, life expectancy, comorbidities, frailty, and patient preference. While both options offer significant benefits to patients in terms of clinical outcomes and quality of life, there is growing interest in expanding the indications for TAVI due to its minimally invasive approach. However, it is worth noting that there are several discrepancies in TAVI outcomes in regards to various endpoints, including death, stroke, and major cardiovascular events. It is unclear why these discrepancies exist, but potential explanations include the diversity of etiologies for aortic stenosis, complex patient comorbidities, and ongoing advancements in both medical therapies and devices. Of these possibilities, we propose that phenotypic variation of aortic stenosis has the most significant impact on post-TAVI clinical outcomes. Such variability in phenotypes is often due to a complex interplay between underlying comorbidities and environmental and inherent patient risk factors. However, there is growing evidence to suggest that patient genetics may also play a role in aortic stenosis pathology. As such, we propose that the selection and management of TAVI patients should emphasize a precision medicine approach.