Transcatheter aortic valve replacement (TAVR) is now a mature technique undertaken for symptomatic severe aortic stenosis irrespective of the level of estimated surgical risk. Thousands of patients benefit from a percutaneous “in conscious” intervention with a short hospital stay and quick recovery for most, challenging the surgical gold standard. TAVR device design and delivery systems differ from one to another, including balloon-expandable, self-expanding, and mechanically expanded devices. Their ability to obtain a predictable and optimal positioning is an undisputable priority, although optimal depth of implantation is not well established according to each type of device. Optimal TAVR positioning involves: 1) a stable and predictable deployment; 2) repositioning by partial or full resheathing; and 3) retrieval during deployment process or once fully deployed. However, most of the available devices do not have all these technological features.
[...]
Assessing the net clinical benefit of recapturing in a randomized trial is less likely to happen. Attizzani et al. provide valuable data and have paved the way for future research. Going further would require the same high-quality standard of data collection including systematic brain magnetic resonance imaging and/or histopathological assessment of emboli protection device–captured debris to more finely assess the safety of repositioning feature of SE-TAVR. Meanwhile, whether anyone would dare abandon repositioning self-expanding TAVR is unlikely.
