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Brain & Heart TAVR in low gradient aortic stenosis

8. Future directions Acknowledgments

Recent studies have focused on elucidating the most None.
effective patient selection criteria and procedural
techniques for TAVR in LFLGAS. Ongoing research aims Funding
to refine risk stratification models and identify the outcome None.
predictors. Novel imaging modalities such as intracardiac
echocardiography and nuclear imaging may help provide Conflict of interest
insights regarding valve morphology and function, guiding The authors declare they have no competing interests.
treatment decisions and optimizing procedural outcomes.
In TAVR, the potential for personalized risk assessment Author contributions
and treatment planning is demonstrated by the integration
of sophisticated technologies, such as artificial intelligence Conceptualization: Tom Kai Ming Wang
and machine learning algorithms. Emerging trends in Writing – original draft: Muhammad Majid, Akiva
TAVR for patients with LFLGAS involve the exploration Rosenzveig, Elio Haroun, Aro Daniela Arockiam,
of alternative access routes, including transaxillary and Ankit Agrawal, Sharmeen Sorathia, Rochell Issa,
TA approaches, to mitigate procedural risks and expand Tiffany Dong, Nithila Sivakumar
treatment options for patients with complex anatomy. Writing – review & editing: Muhammad Majid, Akiva
92
In addition, the advancement of next-generation THV Rosenzveig, Tom Kai Ming Wang
with enhanced hemodynamics and durability addresses
the distinctive challenges posed by LFLGAS, potentially Ethics approval and consent to participate
improving long-term valve performance and patient Not applicable.
outcomes. Despite significant advancements, challenges
52
remain in optimizing outcomes and expanding the Consent for publication
applicability of TAVR in patients with LFLGAS. Addressing Not applicable.
issues, such as paravalvular leaks, conduction disturbances,
and PPM is crucial for improving procedural success Availability of data
and long-term durability. Innovations in valve design,
93
delivery systems, and optimal antithrombotic strategy aim Not applicable.
to minimize complications and improve the safety profile References
of TAVR. 93
1. Gurvitch R, Cheung A, Ye J, et al. Transcatheter valve-in-
9. Conclusion valve implantation for failed surgical bioprosthetic valves.
J Am Coll Cardiol. 2011;58:2196-2209.
This contemporary review of TAVR in patients with
LFLGAS underscores the evolving landscape of clinical doi: 10.1016/j.jacc.2011.09.009
perspectives, procedural considerations, outcomes, 2. Baumgartner H, Hung J, Bermejo J, et al.
complications, and future directions in this specialized field Recommendations on the echocardiographic assessment
of cardiovascular intervention. The clinical perspectives of aortic valve stenosis: A focused update from the
highlighted in these studies highlight the importance european association of cardiovascular imaging and
of adhering to guidelines for patient selection and the American society of echocardiography. J Am Soc
intervention, particularly in identifying individuals who Echocardiogr. 2017;30:372-392.
may benefit from TAVR rather than SAVR. Furthermore, doi: 10.1016/j.echo.2017.02.009
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the studies illustrate the favorable outcomes and feasibility 3. Contorni F, Fineschi M, Iadanza A, Santoro A, Mandoli GE,
of TAVR in low-risk patients with symptomatic severe AS, Cameli M. How to deal with low-flow low-gradient aortic
emphasizing the potential expansion of TAVR to a broader stenosis and reduced left ventricle ejection fraction: From
patient population. These studies collectively contribute literature review to tips for clinical practice. Heart Fail Rev.
94
to the understanding of procedural considerations, patient 2022;27:697-709.
outcomes, and the expanding role of TAVR in addressing doi: 10.1007/s10741-021-10090-0
the complexities of LFLGAS. These findings underscore
the need for continuous research and innovation to 4. Lauten A, Zahn R, Horack M, et al. Transcatheter aortic
improve patient outcomes in this challenging patient valve implantation in patients with low-flow, low-gradient
population while establishing the basis for potential aortic stenosis. JACC Cardiovasc Interv. 2012;5:552-559.
broader applications of TAVR in low-risk patients with AS. doi: 10.1016/j.jcin.2012.04.001

Volume 3 Issue 1 (2025) 14 doi: 10.36922/bh.4017