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Transcatheter aortic valve implantation (TAVI): the hype and the hope.

Year: 2013
Type: article
Abstract: No medical therapy is available for successfully treating calcific aortic stenosis. Treatments that have been used to slow the progression of coronary artery disease have failed to prevent the progression of aortic stenosis or to reverse the damage. The primary treatment for severe aortic stenosis is aortic valve replacement surgery. The survival rate at 3 years in patients with symptomatic aortic stenosis who undergo surgery is 87%; in those who do not have surgery, it is 21% (P <0.001). The operative mortality rate in the surgical treatment of aortic stenosis is less than 5%, but at least 30% to 40% of patients with severe aortic stenosis go untreated.1,2 Surgical treatment of severe aortic stenosis has been underused for many reasons. Patients are thought to be too old, or they have left ventricular dysfunction or comorbidities that affect the surgical scores. Alternatively, patients are not referred for surgery because they are misdiagnosed (that is, the severity of the aortic stenosis is underestimated) or are considered “asymptomatic” when they are actually very limited in functional class. In addition, patients can perceive temporary improvement in symptoms after medical therapy.3 All of the above reasons emphasize the major issue in the underuse of surgical treatment: an incomplete understanding of the true surgical risk. Balloon aortic valvuloplasty is not an alternative to surgical aortic valve replacement. It provides symptomatic benefits for only a limited time (a few months, if at all) and has a minimal physiologic impact. When the hemodynamic effects of balloon aortic valvuloplasty and bioprosthetic aortic valve replacement are compared at 1 year, the latter affects a larger orifice area (2.07–2.1 cm2 vs 0.78–0.09 cm2) and has a more favorable mean gradient effect (5.8–6.5 mmHg vs 28.2–30 mmHg).4 Although surgical aortic valve replacement has been the mainstay of therapy for severe aortic stenosis, transcatheter aortic valve implantation (TAVI) is now an acceptable standard of care for patients with symptomatic aortic stenosis who are not eligible for surgery or who are at very high risk for surgical treatment. The development of transcatheter devices has progressed rapidly during the last decade, and this approach challenges surgical repair as the preferred or only option for treating severe symptomatic aortic stenosis. In 2002, Alan Cribier led the team that performed the first percutaneous transcatheter implantation of an aortic valve prosthesis in a patient with calcific aortic stenosis. They used an antegrade transseptal approach with a 23-mm balloon-expandable valve.5 In performing the first clinical retrograde transcatheter implantation of an aortic valve prosthesis, David Paniagua and his team used a femoral 16F introducer system that deployed a 20-mm balloon-expandable frame.6
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W154803444
FWCI: 1.091
Cites: 13
Cited by: 13
Related to: 10