Trial lecture as part of a habilitation procedure in cardiology
The lecture will provide a structured overview of the evolving management of aortic stenosis, with particular emphasis on lifelong treatment planning, redo feasibility, and optimization of the index transcatheter aortic valve implantation (TAVI) procedure.
The presentation will begin with a concise review of the natural history of aortic stenosis, including disease progression, and the adverse prognosis associated with untreated severe disease. The principal treatment strategies will then be introduced (surgical aortic valve replacement (SAVR) and TAVI). Particular attention will be given to the expansion of TAVI from inoperable and high-risk patients to younger and lower-risk populations. This change has made lifetime management increasingly important, as the index-TAVI must not only provide an immediate good outcome but also preserve future treatment options.
The second part of the lecture will address factors at the index-TAVI that may influence valve durability and the feasibility of future interventions. The lecture will then focus on transcatheter heart valve (THV) stent-frame expansion and geometry. The potential role of post-dilatation at nominal volume, referred to as the “double-tap” technique, will also be discussed.
The main focus of the presentation will be the Left Main (LM) View fluoroscopic projection. This projection allows visualization of the LM coronary ostium during balloon-expandable TAVI and enables assessment of the relationship between the THV outflow (neo-skirt plane), and the coronary-risk plane. Its potential value in preserving coronary access and the feasibility of redo-TAVI, as well as estimating the risk of future coronary obstruction will be explained.
The lecture will conclude by proposing a practical strategy for optimization of the index procedure: to achieve optimal THV expansion, and to potentially preserve coronary access/ redo feasibility with standardized documentation of redo-relevant anatomy.