Abstract
The development of transcatheter aortic valve replacement (TAVR) can certainly be considered one of the most fascinating examples of successful translational research in medicine. Thanks to an outstanding partnership between multidisciplinary clinicians and engineers, we could move from concept to bench, bench to bedside, bedside to clinical feasibility trials, then on to larger clinical registries and evidence based trials, leading ultimately to a breakthrough technology with durable impact on the pattern of medical practice. This disruptive technology evoked scepticism and criticism in the beginning, but thanks to innumerable clinical trials and evidence based investigations, it is now widely accepted by the medical community and its acceptance is continuing to grow. In the last fourteen years, TAVR has been performed in around 300,000 patients in 65 countries and adoption is increasing by 40% year on year. The field of TAVR is rapidly evolving, with major refinements in technology, procedural techniques, patient selection and biomedical engineering. With the development of better devices, new approaches and new implantation strategies, TAVI has become much simpler and safer. The indications were initially limited to elderly aortic stenosis patients with multiple co-morbidities. The same are now cautiously and appropriately growing to include a broader population of patients with lower surgical risk, degenerated surgical bioprosthesis, and even patients with other valvular diseases such as pure aortic or even mitral insufficiency. There are few examples of clinical fields in medicine that match the rapid and careful evolution of TAVI.
Highlights
The development of transcatheter aortic valve replacement (TAVR) can certainly be considered one of the most fascinating examples of successful translational research in medicine
TAVR resulted in larger aortic-valve areas and lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation - whereas surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation
TAVR appears today a breakthrough technology, challenging the foundations of medical practice, enabling thousands of patients with severe aortic stenosis (AS) to receive a life-saving effective alternative treatment to surgical aortic valve replacement (SAVR). This would not have been possible without the excellent and unequalled collaborative spirit between clinicians and engineers who have provided their expertise with the unique goal of making this procedure not just possible, and safe and successful
Summary
The development of transcatheter aortic valve replacement (TAVR) can certainly be considered one of the most fascinating examples of successful translational research in medicine. Thanks to an outstanding partnership between multidisciplinary clinicians and engineers, we could move from concept to bench, bench to bedside, bedside to clinical feasibility trials, on to larger clinical registries and evidence based trials, leading to a breakthrough technology with durable impact on the pattern of medical practice. This disruptive technology evoked scepticism and criticism in the beginning, but thanks to innumerable clinical trials and evidence based investigations, it is widely accepted by the medical community and its acceptance is continuing to grow.
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