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Editorials

Transcatheter Aortic Valve Implantation

Past, Present, and Future

Howard C. Herrmann, MD

From the Interventional Cardiology and Cardiac Catheterization Laboratories, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pa.

Correspondence to Howard C. Herrmann, MD, University of Pennsylvania School of Medicine, 9038 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104. E-mail howard.herrmann@uphs.upenn.edu

Key Words: aorta • stenosis • valves • valvuloplasty

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
For patients with symptomatic critical aortic stenosis, aortic valve replacement improves survival. However, the risks of open heart surgery have prompted investigation of alternative therapies, including balloon aortic valvuloplasty and transcatheter aortic valve implantation (tAVI).

Article see p 167

	Past

 
At centers participating in the Society of Thoracic Surgery national database, the 30-day operative mortality in patients undergoing isolated aortic valve replacement is now <4%.¹ This often-quoted risk, which includes young patients and those with bicuspid valves but excludes morbidity, may therefore represent only the floor of risk. In an older, but more inclusive, study from the National Medicare Database of patients 65 years of age, the average mortality was 8.8% and was as high as 13.0% in some centers.² The risk of aortic valve replacement increases with age and other comorbidities, including emergency and prior cardiac surgery, lung and renal disease, small body surface area, history of stroke, atrial fibrillation, heart failure, and the need for associated coronary revascularization.³ Some patients may be truly inoperable or denied surgery because of the presence of a porcelain aorta, prior radiation, cirrhosis, generalized frailty, or physician or patient preference.⁴ A nonsurgical alternative for these patients is both welcome and needed.

In the past, high-risk and inoperable patients were offered balloon aortic valvuloplasty. This procedure remains an important palliative option but does not alter the natural history of aortic stenosis nor provide an improvement in survival.⁵ The current era of transcatheter aortic valve implantation built on this procedure and began with the first demonstration . . . [Full Text of this Article]

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