Transcatheter Aortic Valve Implantation

Abstract

Percutaneous catheter-based interventions are an emerging area in the treatment of valvular heart disease. Percutaneous aortic balloon valvuloplasty was initially introduced by Cribier et al1 in 1985 for patients with severe calcific aortic stenosis. This technique results in moderate hemodynamic improvement and significant clinical improvement, but it is associated with significant periprocedural morbidity and mortality and with a very high hemodynamic and clinical restenosis within 6 to 12 months after the procedure.2 Today, this technique is used mainly as a bridging technique to surgical aortic valve replacement (AVR) or to transcatheter aortic valve implantation (TAVI).2–4 The early results of percutaneous catheter-based valve replacement are promising. The first percutaneous heart valve replacement was performed by Bonhoeffer in 2002 in the pulmonary position5,6 and by Cribier in 2002 in the aortic position.7,8 Nowadays, TAVI has evolved to become a valid therapeutic option for patients with severe aortic stenosis who are inoperable or are at very high risk for surgical AVR.7–10 Recently, TAVI has been offered to select patients with good results. In Europe, TAVI is now an established, evidence-based alternative to open AVR in patients with aortic stenosis who are unsuitable for conventional cardiac surgery. Recent reported studies from the United States have demonstrated that for patients with severe aortic stenosis who are not candidates for surgery, TAVI with the Edwards SAPIEN valve significantly reduced mortality compared with standard treatment (Placement of Aortic Transcatheter Valves [PARTNER] trial, cohort B).9,10 Currently, there are 2 first-generation percutaneous valves in clinical application, a balloon-expandable Edwards SAPIEN and a self-expandable valve (CoreValve), with several other second-generation new players achieving first-in-human application. Since 2002 when the first TAVI in a human was reported by Cribier et al,7 percutaneous heart …