Evolutions in planning and execution of transcatheter aortic and mitral valve interventions

This thesis investigated developments in transcatheter valve replacement and repair. In part 1A, balloon dilatation of aortic valve stenosis showed to be a feasible bridging therapy to definite valve replacement in half of the investigated population. Part 1B described patients undergoing transcatheter aortic valve implantation (TAVI) during the Covid-19 pandemic and found that these patients had poorer cardiac function than patients from a previous period. In part 1C the axillary artery as an alternative access for TAVI was investigated. This artery was a suitable access site, however, dedicated closure techniques are lacking. Part 1D evaluated early discharge after TAVI. Two-thirds of patients were discharged within 48hrs after procedure. Conduction disturbances and prolonged observation were the major reasons for non-early discharge. Clinical endpoints did not differ between early and non-early discharge groups. Patient selection contributed to safe and accelerated discharge.

In part 2, mitral valve edge-to-edge repair was assessed. Proportionality of mitral regurgitation provided no explanation for therapeutic success in a multicenter registry. An initial benefit of edge-to-edge repair diminished during follow-up. Durable treatment of mitral regurgitation using this technique was not always possible.

Part 3 investigated the use of computed tomography derived three-dimensional computational models (3DCM) in complex transcatheter cardiac interventions. We demonstrated the planning of transcatheter mitral valve replacement using 3DCM. Determination of valve type, implantation depth and assessment of complications were supported by the use of 3DCM.