Treatment of valvular heart disease has entered a new era, in particular with the introduction and more widespread adoption of transcatheter aortic valve implantation (TAVI). Despite excellent long-term results from surgical correction there remain a significant proportion of patients who are denied surgical treatment due to multiple co-morbidities. TAVI now offers a new treatment for patients with severe symptomatic aortic stenosis who would otherwise have a poor prognosis without intervention. We highlight the role for this rapidly evolving technology and, as a an example, present a case scenario with a patient™s journey through a TAVI programme. The limited outcome data are presented and the new state-of-the-art devices are also discussed.
Aortic stenosis, transcatheter aortic valve, high-risk, non-coronary intervention, balloon valvuloplasty
Disclosure: The authors have no conflicts of interest to declare.
Received: 16 July 2009 Accepted: 10 August 2009
Correspondence: GW Mikhail, Department of Cardiology, St Mary™s Hospital, Imperial College NHS Trust, Praed Street, London, W2 1NY, UK. E: firstname.lastname@example.org
Aortic valve stenosis is the most common valve disorder in the general adult population1├óÔé¼ÔÇ£3 and its prevalence increases with age.4,5 If symptomatic and left untreated, it is invariably unilaterally fatal, with mortality rates in patients who are either turned down or decline surgery of 36% at one year, 68% at five years and 82% at 10 years.5,6 In the elderly, who have more co-morbidities such as renal impairment and left ventricular dysfunction, the prognosis is worse. One study demonstrates a 12-fold increase in mortality in octogenarians followed up to 36 months who did not undergo valve replacement. Interestingly, the strongest predictor of mortality in that cohort, by multivariate analysis, was refusal to undergo surgery.7,8 Additionally, a number of studies have also reported that 30├óÔé¼ÔÇ£60% of patients with aortic stenosis are not referred for assessment. This highlights the possible misconceptions of some physicians.5,9
We have seen a paradigm shift in the last five years, namely the emergence of new technologies that can offer alternative percutaneous treatment strategies. This article appraises and informs the reader on the current state-of-the-art devices and techniques available, as well as providing some insights into the newer secondgeneration devices.
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