Transcatheter Aortic Valve Implantation

Degenerative aortic valve stenosis accounts for the majority of native valve diseases and the prognosis is poor for symptomatic patients if untreated. Owing to the progressive aging of the population, the incidence of symptomatic aortic stenoses will further increase. Surgical aortic valve replacement provides a valuable treatment option with a well-documented favorable long-term outcome. However, the risk of surgery increases especially in older patients with significant comorbidities. For this reason, one third of symptomatic patients is not considered suitable for surgery. Transcatheter off-pump aortic valve implantation, however, using a transfemoral or a transapical approach may be a suitable therapeutic option for these patients. The balloon-expandable Edwards-SAPIEN prosthesis and the self-expandable Medtronic Core- Valve system have received CE approval and more than 10,000 patients have been treated worldwide. Both methods share the same main principles: after crossing the stenotic aortic valve, balloon valvuloplasty is performed during a short episode of rapid ventricular pacing to predilate the native valve. After careful positioning of the valve prosthesis using either transesophageal echocardiography or fluoroscopy or both, the valve is released. 30-day mortality ranges between 8% and 15% in different registries in higher-risk patients. Nonetheless, larger randomized trials are warranted in order to validate the safety and effectiveness of this new approach.