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European Heart Journal Advance Access published online on May 12, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn183
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© 2008 The European Society of Cardiology, European Association for Cardio-Thoracic Surgery, and Europa Edition, All rights reserved. For permissions please email: journals.permissions@oxfordjournals.org

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)

Alec Vahanian1,*, Ottavio Alfieri2,*, Nawwar Al-Attar1, Manuel Antunes3, Jeroen Bax4, Bertrand Cormier5, Alain Cribier6, Peter De Jaegere7, Gerard Fournial8, Arie Pieter Kappetein7, Jan Kovac9, Susanne Ludgate10, Francesco Maisano2, Neil Moat11, Friedrich Mohr12, Patrick Nataf1, Luc Piérard13, José Luis Pomar14, Joachim Schofer15, Pilar Tornos16, Murat Tuzcu17, Ben van Hout18, Ludwig K. Von Segesser19 and Thomas Walther12

1 Hôpital Bichat, Paris, France
2 Ospedale San Raffaele, Milan, Italy
3 University Hospital, Coimbra, Portugal
4 Leiden University Medical Center, Leiden, The Netherlands
5 Institut Hospitalier Jacques Cartier, Massy, France
6 CHU de Rouen—Hôpitaux de Rouen—Hôpital Charles Nicolle, Rouen Cedex, France
7 Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
8 CHU—Centre Hospitalier de Rangueil, Toulouse, France
9 University Hospitals of Leicester, Leicester, UK
10 Department of Health, Medicines and Healthcare Products Regulatory Agency, London, UK
11 Royal Brompton Hospital, London, UK
12 Heart Center Leipzig, University of Leipzig, Leipzig, Germany
13 University Hospital Sart Tilman, Liege, Belgium
14 Hospital Clinico de Barcelona, Univerisity of Barcelona, Barcelona, Spain
15 Hamburg University Cardiovascular Center, Hamburg, Germany
16 Hospital Universitari Vall d’Hebron, Barcelona, Spain
17 Cleveland Clinic, Cleveland, Ohio, USA
18 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
19 CHUV, Lausanne, Switzerland

Received 2 April 2008; accepted 10 April 2008.

* Corresponding authors. Tel: +33 1 40 25 67 60, Fax: +33 1 40 25 67 32, Email: alec.vahanian{at}bch.aphp.fr (A. V.); Tel: +39 2 26437102, Fax: +39 02 26 43 7125, Email: ottavio.alfieri{at}hsr.it (O. A.)

Aims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development.

Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation.

Conclusion: Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion.

Key Words: Aortic stenosis • Valve disease • Percutaneous valve interventions


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