Transcatheter aortic valve implantation in 2012

Transcatheter aortic valve implantation in 2012 During the last decade, transcatheter aortic valve implantation (TAVI) developed rapidly and revolutionized the treatment of severe aortic stenosis. Since the PARTNER A and B trials, this technique has become the reference treatment for inoperable patients and an attractive alternative to surgical aortic valve replacement in those at high risk for surgery. Large registries conducted since 2007, mainly in Europe, confirmed the excellent haemodynamic performances of both commercialized percutaneous valves, the Edwards Sapien and the Medtronic Core Valve, as well as their benefits on patients' symptoms and survival. The whole procedural process, from patient selection to post-procedural care and evaluation of results, should be conducted by a dedicated multi-disciplinary medico-surgical Heart Team, within centres which specialize in valvular heart disease. TAVI is currently limited to high-risk or inoperable patients; however indications will be extended, in particular to surgical bioprotheses failures and to patients at intermediate risk. Firstly, it will be necessary to be able to estimate the durability of percutaneous prostheses, since the available follow-up is seldom longer than 5 years and to further decrease the rate of main complications: strokes, periprosthetic aortic regurgitation and vascular complications. The place of the transfemoral route will increase, due to the miniaturization of the devices, to the detriment of other approaches. However, whatever its modalities a multi-disciplinary approach, excellent imaging and careful evaluation will remain key points for the success of the technique.