From an Unfolding Emergency Treatment to a Universal Shift in Therapy: The History and Evolution of the Catheter-Based Treatment of Aortic Valve Stenosis

Abstract

Aortic valve stenosis (AVS) is the most frequent valvular heart disease in industrialized countries, presenting with very high mortality if left untreated. While drug treatment can sometimes alleviate symptoms, it fails to stop progression or cure the underlying disease. Until the first decade of this millennium, surgical aortic valve replacement (SAVR) remained the only available therapy option with a positive impact on mortality and morbidity. Even though several studies reported highly positive effects of SAVR regarding the improved quality of life and better physical performance, SAVR remained an intervention that, due to its remarkable complexity and the need for heart-lung machine and cardioplegia, was limited by the patients' comorbid profile. While unsatisfying hemodynamic results after transcatheter aortic balloon valvuloplasty in high-risk surgical patients limited its adoption as an alternative treatment, it provided the impetus for further interventional approaches to the therapy of AVS. This review considers the invention and development of transcatheter aortic valve implantation (TAVI), which established itself as a catheter-based, minimally invasive procedure over the past decade, and has become an equivalent treatment method for high-risk surgical patients. For that matter, early TAVI concepts, their amendments, and the associated pioneers are recognized for paving the way to a revolutionary diversification in AVS treatment.

Patient Characteristics and Outcomes Associated with Sentinel Protection Device Use in Patients with Aortic Valve Disease Undergoing TAVR in a “Real-World” Setting

“…Transcatheter aortic valve replacement (TAVR) has become the most widely used treatment in low to high-risk patients with aortic valve disease, exceeding all other forms of Surgical Aortic Valve Replacement (SAVR) in 2019 [ 1 ]. With advances in device technology and increased operator experience, TAVR has become a proven safe and effective treatment method for aortic valve replacement (AVR) [ 2 ]. Although these advances have reduced many of the early complications seen with TAVR, such as vascular complications and paravalvular leaks, concern persists over the increased risk of cerebrovascular accidents secondary to embolization of aortic and aortic valve debris during TAVR.…”