Surgical perspective of Aortic valve disease – The potential role of Percutaneous Valve Technology (pp. 217-240)
Authors: (S. Chris Malaisrie, Virna L. Sales, John Kubasiak,and Patrick M. McCarthy)
Abstract: Transcatheter aortic valve implantation (TAVI) is a revolutionary therapy for patients with aortic valve disease, in particular aortic stenosis (AS). Treatment options for patients with AS have traditionally included aortic valve replacement (AVR), balloon aortic valvuloplasty (BAV), and medical therapy. A recent randomized trial has established TAVI as superior to medical management in patients considered not suitable for standard AVR (by both the cardiac surgeon and cardiologist); and non-inferior to standard AVR in patients considered high-risk (Society of Thoracic Surgeons (STS) predicted risk of mortality greater than 10%).
Future treatment groups may include intermediate-risk patients. However, an appropriate risk threshold remains to be determined, and will depend on the safety of the TAVI procedure, the durability of the stent-valve, and the need for concomitant procedures such as coronary artery bypass, other valve surgery, and atrial fibrillation surgery. The potential roles for transcatheter heart valves are several. A valve-in-valve procedure has impacts beyond a future treatment alternative for patients with failed prosthesis. The potential of a valve-in-valve option influences valve choice and valve size in patients requiring AVR today. Finally, by extending treatment options, TAVI has the potential of reducing the undertreatment of patients with AS.