Percutaneous Transcatheter Aortic Valve Implantation – An update.

Chiam Paul, Chao VT. Asean Heart Journal 2013; 21: 11-14.

Abstract

The prevalence of aortic valve stenosis (AS) increases with advancing age, and the condition is present in 4.6% of adults ≥ 75 years of age

Introduction

The prevalence of aortic valve stenosis (AS) increases with advancing age, and the condition is present in 4.6% of adults ≥ 75 years of age.1 Once symptoms occur, the prognosis is poor with medical therapy, with a 50% mortality rate between 1 and 2 years.2,3 Surgical aortic valve replacement (AVR) is the treatment of choice for the majority of these patients, with relief of symptoms and improved survival.4

However, in a significant number of patients, mainly the very elderly and those with severe comorbidities, the risk of AVR is often considered to be elevated and these patients are not offered surgery.57 The Euroheart survey found that up to 33% of patients with symptomatic severe AS were denied surgery, with advanced age and left ventricular dysfunction being the main factors.8 Although balloon aortic valvuloplasty (BAV) can provide temporary symptomatic relief,9 it does not confer survival benefit.10

Percutaneous transcatheter aortic valve implantation (TAVI) has emerged as an alternative option recently. In 2002, the first-in-man TAVI was performed by Alain Cribier and coworkers.11 They demonstrated that the nonsurgical implantation of a prosthetic heart valve could be achieved with immediate and midterm hemodynamic and clinical improvement. Technological advances have since been made exponentially.

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