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FOCUS ISSUE: VALVULAR HEART DISEASE: STATE-OF-THE-ART PAPER

Outcomes and Safety of Percutaneous Aortic Valve Replacement

Alan Zajarias, MD^_*,_* and Alain G. Cribier, MD

^_* Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
Hôpital Charles Nicolle, Department of Cardiology, University of Rouen, Rouen, France

Manuscript received May 7, 2008; revised manuscript received November 7, 2008, accepted November 13, 2008.

^_* Reprint requests and correspondence: Dr. Alain G. Cribier, Service de Cardiologie, Hôpital Charles Nicolle, 1 Rue de Germont, 76000 Rouen, France (Email: Alain.Cribier{at}chu-rouen.fr).

The concept of transcatheter aortic valve replacement was developed with the goal of offering a therapeutic solution to patients with severe symptomatic aortic stenosis who are not considered good candidates for surgical valve replacement. Initial attempts were complicated by vascular access problems and lack of appropriate tools. With time and experience, early problems were solved and the concepts of valve sizing, valve positioning, and patient selection were defined. Technological improvements allowed the use of smaller arterial sheaths to decrease vascular trauma, special catheters to facilitate valve delivery, and treatments on the valve prostheses that would ensure longer durability. After 5 years, the number of transcatheter aortic valve replacements has grown significantly, and will likely continue as this technology becomes increasingly available. Currently, 2 valve models, the Edwards SAPIEN valve (Edwards Lifescience, Irvine, California) and the CoreValve ReValving system (CoreValve Inc., Irvine, California), have been used in over 4,000 cases worldwide for the treatment of symptomatic aortic stenosis. Midterm follow-up shows no evidence of restenosis or prosthetic valve dysfunction. Transfemoral and transapical delivery routes can be selected depending on the quality of vascular access and the type of prosthesis used. Randomized trials that are currently underway will confirm procedural safety and guide the applicability of this technology.

Key Words: aortic stenosis • valvuloplasty • catheter • stent • survival

Abbreviations and Acronyms   AI = aortic insufficiency   AS = aortic stenosis   AVR = aortic valve replacement   BAV = balloon aortic valvuloplasty   EOA = effective orifice area   LVEF = left ventricular ejection fraction   MACCE = major adverse cardiovascular and cerebrovascular events

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