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Transcatheter aortic valve implantation: the evidence is catching up with reality

Lutz Buellesfeld, Stephan Windecker
DOI: http://dx.doi.org/10.1093/eurheartj/ehq315 133-137 First published online: 3 December 2010

This editorial refers to ‘Transcatheter aortic valve implantation: early results of the FRANCE (FRench Aortic National CoreValve and Edwards) registry’, by H. Eltchaninoff et al. on page 191 and ‘Transcatheter aortic valve implantation: first results from a multi-centre real-world registry’, by R. Zahn et al. on page 198

Degenerative aortic stenosis has become the most common valve disease in Europe and the USA due to prolonged life expectancy and associated degenerative effects on cardiac structures. It is caused by an active pathobiological process which entails chronic inflammation with lipoprotein deposition, osteoblast activation, and extracellular calcification with bone formation.1 Progressive valve obstruction due to immobilized leaflets results in pressure overload, which in turn leads to left ventricular hypertrophy, collagen deposition, relative ischaemia, and diastolic dysfunction with pulmonary congestion (Figure 1). For several decades, surgical aortic valve replacement (SAVR) has been considered the gold standard in the treatment of symptomatic patients, resulting in effective symptom relief and near normalization of prognosis.2

Figure 1

Centre: severe calcific aortic stenosis causes pressure overload followed by left ventricular hypertrophy, collagen deposition, relative ischaemia, and diastolic dysfunction with pulmonary congestion. Left top: transfemoral TAVI with implantation of the Edwards Sapien prosthesis. Left bottom: transapical TAVI with implantation of the Edwards Sapien prosthesis. Right top: transfemoral TAVI with implantation of the Medtronic CoreValve prosthesis. Right bottom: transsubclavian TAVI with implantation of the Medtronic CoreValve prosthesis.

In the search for less invasive treatment modalities, the concept of transcatheter implantation of heart valves was pioneered in experimental models by Henning Andersen3 for the aortic and Philipp Bonhoeffer4 for the pulmonary position, followed by the first percutaneous …