Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Jun 30;32(6):296–301. doi: 10.1002/clc.20535

Transcatheter Aortic Valve Replacement: A Potential Option for the Nonsurgical Patient

Jigar H Patel 1, Sunil T Mathew 2, Thomas A Hennebry 2,✉
PMCID: PMC6653302  PMID: 19569066

Abstract

With improved life expectancy, the incidence of aortic stenosis is rising. However, up to one‐third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to a high operative mortality rate. Such patients can only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement. Clinical trials are investigating these devices in patients with severe aortic stenosis that have been denied surgery. Preliminary results from these trials suggest that transcatheter aortic valve replacement (TAVR) is not only feasible, but an effective way to improve symptoms. In this review, we describe the current technology and display available outcome data. Though technical challenges and operator learning curve limit optimal use of the current technology, continued experience and advancements in technology may one day make TAVR a viable alternative to traditional surgical aortic valve replacement. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (474.8 KB).

References

  • 1. Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997; 29(3): 630–634. [DOI] [PubMed] [Google Scholar]
  • 2. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez‐Sarano M. Burden of valvular heart diseases: a population‐based study. Lancet 2006; 368(9540): 1005–1011. [DOI] [PubMed] [Google Scholar]
  • 3. US Census Bureau. US Interim Projections by Age, Sex, Race, and Hispanic Origin In 2004.
  • 4. Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS. Association of aortic‐valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med 1999; 341(3): 142–147. [DOI] [PubMed] [Google Scholar]
  • 5. Tarantini G, Buja P, Scognamiglio R, et al. Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery. Eur J Cardiothorac Surg 2003; 24(6): 879–885. [DOI] [PubMed] [Google Scholar]
  • 6. Murphy ES, Lawson RM, Starr A, Rahimtoola SH. Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10‐year survival after valve replacement. Circulation 1981; 64(2pt2): II184–II188. [PubMed] [Google Scholar]
  • 7. Connolly HM, Oh JK, Orszulak TA, et al. Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 1997; 95(10): 2395–2400. [DOI] [PubMed] [Google Scholar]
  • 8. Kvidal P, Bergstrom R, Horte LG, Stahle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 2000; 35(3): 747–756. [DOI] [PubMed] [Google Scholar]
  • 9. Iung B, Cachier A, Baron G, et al. Decision‐making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005; 26(24): 2714–2720. [DOI] [PubMed] [Google Scholar]
  • 10. Cribier A, Eltchaninoff H, Tron C, et al. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end‐stage inoperable patients with calcific aortic stenosis. J Am Coll Cardiol 2004; 43(4): 698–703. [DOI] [PubMed] [Google Scholar]
  • 11. Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self‐expanding valve prosthesis in high‐risk patients with aortic valve disease: the Siegburg first‐in‐man study. Circulation 2006; 114(15): 1616–1624. [DOI] [PubMed] [Google Scholar]
  • 12. Grube E, Schuler G, Buellesfeld L, et al. Percutaneous aortic valve replacement for severe aortic stenosis in high‐risk patients using the second‐ and current third‐generation self‐expanding CoreValve prosthesis: device success and 30‐day clinical outcome. J Am Coll Cardiol 2007; 50(1): 69–76. [DOI] [PubMed] [Google Scholar]
  • 13. Chiam P, Ruiz C. Percutaneous transcatheter aortic valve implantations: assessing results, judging outcomes, and planning trials. JACC: Cardiovasc Interv 2008; 1(4): 341–350. [DOI] [PubMed] [Google Scholar]
  • 14. Buellesfeld L, Gerckens U, Grube E. Percutaneous implantation of the first repositionable aortic valve prosthesis in a patient with severe aortic stenosis. Catheter Cardiovasc Interv 2008; 71(5): 579–584. [DOI] [PubMed] [Google Scholar]
  • 15. Low RI BS, Yeo KK, Ebner A. Direct flow medical percutaneous aortic valve: proof of concept. Eurointervention 2008; 4: 256–261. [PubMed] [Google Scholar]
  • 16. Lichtenstein SV, Cheung A, Ye J, et al. Transapical transcatheter aortic valve implantation in humans: initial clinical experience. Circulation 2006; 114(6): 591–596. [DOI] [PubMed] [Google Scholar]
  • 17. Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation 2006; 113(6): 842–850. [DOI] [PubMed] [Google Scholar]
  • 18. Cribier A, Eltchaninoff H, Tron C, et al. Treatment of calcific aortic stenosis with the percutaneous heart valve: mid‐term follow‐up from the initial feasibility studies: the French experience. J Am Coll Cardiol 2006; 47(6): 1214–1223. [DOI] [PubMed] [Google Scholar]
  • 19. Webb JG, Pasupati S, Achtem L, Thompson CR. Rapid pacing to facilitate transcatheter prosthetic heart valve implantation. Catheter Cardiovasc Interv 2006; 68(2): 199–204. [DOI] [PubMed] [Google Scholar]
  • 20. Webb JG, Pasupati S, Humphries K, et al. Percutaneous transarterial aortic valve replacement in selected high‐risk patients with aortic stenosis. Circulation 2007; 116(7): 755–763. [DOI] [PubMed] [Google Scholar]
  • 21. Ye J, Cheung A, Lichtenstein SV, et al. Six‐month outcome of transapical transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg 2007; 31(1): 16–21. [DOI] [PubMed] [Google Scholar]
  • 22. Pasupati S, Humphries K, AlAli A, et al. Abstract 1700: Balloon Expandable Aortic Valve [BEAV] Implantation. The first 100 Canadian patients. Circulation. Oct 2007; 116: II_357.
  • 23. Svensson LG, Dewey T, Kapadia S, et al. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann Thorac Surg 2008; 86(1): 46–55. [DOI] [PubMed] [Google Scholar]
  • 24. Walther T, Simon P, Dewey T, et al. Transapical minimally invasive aortic valve implantation: multicenter experience. Circulation 2007; 116(suppl 11): I240–I245. [DOI] [PubMed] [Google Scholar]
  • 25. Vahanian A, Alfieri O, Al‐Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio‐Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008; 29(11): 1463–1470. [DOI] [PubMed] [Google Scholar]
  • 26. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16(1): 9–13. [DOI] [PubMed] [Google Scholar]
  • 27. Shroyer AL, Coombs LP, Peterson ED, et al. The Society of Thoracic Surgeons: 30‐day operative mortality and morbidity risk models. Ann Thorac Surg 2003; 75(6): 1856–1865. [DOI] [PubMed] [Google Scholar]
  • 28. Ambler G, Omar RZ, Royston P, Kinsman R, Keogh BE, Taylor KM. Generic, simple risk stratification model for heart valve surgery. Circulation 2005; 112(2): 224–231. [DOI] [PubMed] [Google Scholar]
  • 29. Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48(3): e1–e148. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES