Abstract
Degenerative heart valve disease is associated with significant morbidity and mortality and healthcare expenditures. Transcatheter heart valve repair and replacement has introduced a fundamental change in the therapeutic management and transcatheter aortic valve replacement (TAVR) has gained substantial popularity. Favorable results from randomized trials and large real world registries lead to TAVR being considered a standard procedure with high rates of procedural success and low rates of peri-procedural complications. This article aims to review the past evolution, summarize the available evidence, discuss current indications and limitations and venture a glimpse into the future of percutaneous interventions for aortic valve disease.
Highlights
Degenerative heart valve disease is frequently observed in the elderly and associated with a significant impact on patient morbidity and mortality [1], as well as healthcare expenditures [2]
Since the first transcatheter treatment of symptomatic severe aortic stenosis in 2002 [4], transcatheter aortic valve replacement (TAVR) has gained substantial popularity, and favorable results from randomized trials and large real world registries supported the fast expansion of TAVR
Whether guideline recommendations will be limited to patients with severe aortic stenosis in patients with preexisting heart failure will be evaluated in the TAVR UNLOAD trial (Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure) [67, 68]
Summary
Degenerative heart valve disease is frequently observed in the elderly and associated with a significant impact on patient morbidity and mortality [1], as well as healthcare expenditures [2]. The advent of transcatheter heart valve repair and replacement has introduced a fundamental change in the therapeutic management of patients with significant heart valve disease. During the past 17 years, a rapid adoption of TAVR was observed with increasing annual rates of TAVR procedures, whereas the ratio of observed vs expected rates of mortality continuously declined [5]. At this point in time, TAVR is established and considered a standard procedure with high rates of procedural success and low rates of peri-procedural complications. This article will thoroughly review the past evolution of transcatheter aortic valve techniques, summarize the available evidence, discuss current indications and limitations and venture a glimpse into the future of percutaneous interventions for aortic valve disease
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