Transcatheter Valve Implantation for Patients with Aortic Stenosis

Grégory Ducrocq, Dominique Himbert, Eric Brochet, Alec Vahanian
Interventional Cardiology, 2009;4(1):34-38
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Abstract

Seven years after the first-in-man transcatheter aortic valve implantation (TAVI) for the treatment of aortic stenosis, it remains a dynamic field of research and development. Evidence from 8,000 patients treated worldwide suggests that TAVI is feasible and provides haemodynamic and clinical improvement for up to three years in patients at high risk or with contraindications to surgery. Pending questions mainly concern safety and long-term durability. Today these techniques are targeted at high-risk patients, but they may be extended to lower-risk groups in the future if their initial promise holds true after careful evaluation.
Keywords
Aortic stenosis, aortic valve replacement, transcatheter valve intervention
Disclosure Grégory Ducrocq and Eric Brochet have no conflicts of interest to declare. Dominique Himbert is a Proctor for Edwards Lifesciences. Alec Vahanian is a Consultant for Edwards Lifesciences.
Received: July 07, 2009 Accepted August 25, 2009
Correspondence: Alec Vahanian, Cardiology Department, Bichat Hospital, 46 rue Henri Huchard, Paris 15018, France. E: alec.vahanian@bch.aphp.fr

Aortic stenosis (AS) is currently the most frequent native valve disease in Europe and is most often seen in elderly patients with co-morbidities.1 Valve replacement is the definitive therapy for patients with severe AS who have symptoms or objective consequences such as left ventricular (LV) dysfunction.2,3 However, the risk of surgery may be higher in elderly patients with significant co-morbidities.4,5 In addition, several registries show that referring physicians often do not propose surgery, as was the case in the Euro Heart Survey with 33% of patients with severe valve disease and severe symptoms not being considered for surgery.6 Thus, despite the good results of valve surgery, there may well be a role for less invasive alternatives. Balloon aortic valvuloplasty (BAV) is now rarely used, mainly due to its limited long-term efficacy.2,3 This article will address the potential indications for TAVI and the various steps of the procedure, and will summarise the results that are currently available.

Potential Indications for Transcatheter Aortic Valve Implantation

The selection of candidates for TAVI, and especially risk assessment, should involve multidisciplinary consultation between cardiologists, surgeons, imaging specialists and anaesthesiologists, all having experience in the management of valve disease.8 TAVI should be performed only in severe AS. Echocardiography is the preferred tool for assessing the severity of AS according to a combination of measurements of the valve area and flow-dependent indices. In patients with a low LV ejection fraction and low-gradient, low-dose dobutamine, echocardiography is useful to differentiate between severe and the rare ‘pseudo-severe’ AS.2,3

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