Transcatheter Aortic Valve Therapies: From Cutting Edge to Mainstream

Abstract

Surgical valve replacement has been the standard of care for patients who present with clinically apparent severe valvular heart disease and has a track record exceeding half a century. Yet, over a decade ago it became clear that a substantial number of patients who had a formal indication for valve surgery were not treated because of age, left ventricular dysfunction or presence of co-morbidities. In 2002 Professor Alain Cribier from Rouen successfully performed the first–in-human transcatheter aortic valve implantation (TAVI) in an inoperable patient with severe aortic valve stenosis (AS). Transcatheter valve interventions typically involve a small incision in the groin to introduce catheters in a femoral vessel and can be executed in a completely percutaneous fashion. When the femoral vessels are not accessible, alternative access options such as the left ventricular apex, ascending aorta or subclavian/axillary artery currently mandate surgical exposure. TAVI is arguably less invasive than surgical aortic valve replacement that generally includes sternotomy and cardiopulmonary bypass. With a paucity of long-term clinical data, no durability warranties and elevated procedural costs, TAVI is currently reserved for patients who are inoperable or considered high risk for conventional surgery. Patient selection, procedural safety and long-term efficacy are key facets for this dynamic technology in motion. Patient work up for TAVI therefore