Transcatheter aortic valve implantation (TAVI) has become a widely accepted strategy for the treatment of aortic stenosis in patients at intermediate, high, or prohibitive surgical risk. After >1 decade of innovation and clinical trial experience, the available technology for TAVI has grown enormously, and now includes a myriad of vascular access approaches and innovative valve designs. As a result, the range of patients who can benefit from these advances continues to grow rapidly. Furthermore, given the improved safety profile and clinical success of current-generation devices in randomized trials, the use of TAVI among even low-risk populations is justified in current trials. With the rapid dissemination and expansion of this technology, operators need to have a comprehensive understanding of how to select the appropriate procedural approach for each individual patient. In this Review, we detail the current evidence for TAVI among different patient populations, discuss the different vascular access approaches currently in use, and explore differences in design features among currently available and investigational valve systems. Furthermore, we provide an overview of important considerations for special patient populations, such as those with existing mitral prostheses, bicuspid aortic stenosis, isolated aortic regurgitation, or severe left ventricular outflow tract calcification.

中文翻译：

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使用不断扩展的TAVI设备满足患者需求

经导管主动脉瓣植入术（TAVI）已成为中，高或禁止手术风险患者的主动脉瓣狭窄治疗的一种广泛接受的策略。经过十多年的创新和临床试验经验，用于TAVI的可用技术得到了巨大的发展，现在包括无数的血管通路和创新的瓣膜设计。结果，可以从这些进展中受益的患者范围继续迅速增长。此外，鉴于随机试验中当前设备的安全性得到了改善，并且临床上取得了成功，因此在当前试验中，即使在低风险人群中也应使用TAVI。随着这项技术的迅速传播和扩展，操作员需要全面了解如何为每个患者选择合适的程序方法。在这篇综述中，我们详细介绍了不同患者人群中TAVI的当前证据，讨论了目前使用的不同血管通路方法，并探讨了当前可用的和研​​究用的瓣膜系统在设计功能上的差异。此外，我们提供了针对特殊患者群体的重要考虑因素的概述，例如具有现有二尖瓣假体，二尖瓣主动脉瓣狭窄，孤立性主动脉瓣关闭不全或严重的左心室流出道钙化的患者。并探讨当前可用和研究用的阀门系统之间在设计功能上的差异。此外，我们提供了针对特殊患者群体的重要考虑因素的概述，例如具有现有二尖瓣假体，二尖瓣主动脉瓣狭窄，孤立性主动脉瓣关闭不全或严重的左心室流出道钙化的患者。并探讨当前可用和研究用的阀门系统之间在设计功能上的差异。此外，我们提供了针对特殊患者群体的重要考虑因素的概述，例如具有现有二尖瓣假体，二尖瓣主动脉瓣狭窄，孤立性主动脉瓣关闭不全或严重的左心室流出道钙化的患者。