Keywords: transcatheter aortic valve implantation (TAVI), antitrombotic treatment, patient specific computersimulation, reducing risks of TAVI

"Reducing the risks of transcatheter aortic valve implantation"

This dissertation looked at how to reduce the risks associated with transcatheter aortic valve implantation (TAVI). It was shown that for both patients with and without a chronic indication for oral anticoagulants, there was evidence that aspirin or oral anticoagulants without supplemental clopidogrel (anticoagulant) significantly reduced bleeding complications after TAVI without increasing thromboembolic complications (clotting). It was also observed that patient-specific computer modeling retrospectively was able to correctly predict the outcomes of TAVI in patients with bicuspid aortic valve stenosis (narrowing of the aortic valve in two places), in which optimal sizing and positioning of the valve prosthesis as advised by the computer model was associated with significantly less severe paravalvular leakage (leakage past the valve prosthesis) and mortality. Also, when in doubt between the two valve sizes, the computer model can provide additional information and help physicians choose the best fitting valve size. Moreover, the new MANTA closure device was shown to be a safe alternative for vascular access closure after TAVI. Finally, this thesis examined the incidence of percutaneous coronary intervention after TAVI, which was found to be low and also well technically possible.

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Language: Dutch