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Trans-apical Aortic valve USA experience (pp. 263-274) $100.00
Authors:  (Lars Svensson)
The field of management of critical aortic valve stenosis has expanded rapidly, particularly with percutaneous aortic valves [1-23]. Aortic valve stenosis in the general population in the United States is increasing and indeed 2.2% of patients over the age of 75 have severe aortic valve stenosis as defined as 0.8cm2 or smaller aortic orifice. Cardiac surgeons are increasingly operating on older patients and the number of patients that are not undergoing surgery appears to vary across the country. Data from Southern California shows that approximately two-thirds of patients with severe aortic valve stenosis do not undergo aortic valve replacement despite the fact that aortic valve replacement is one of the most successful cardiovascular procedures there is as far as improving quality of life and also longevity. In Europe, a similar high rate of not operating on severe aortic valve stenosis also has been reported. Part of the reason for these patients not undergoing surgery are because of comorbidity, patients being elderly and frail, and patients or their families not wishing to proceed with a procedure. This is despite the fact that in patients with symptomatic aortic valve stenosis only approximately 40% will be alive within a year of developing symptoms associated with severe aortic valve stenosis. Of interest the classic Ross-Braunwald curve of survival after development of symptoms still holds true based on an analysis on patients with severe aortic valve stenosis in the Medicare population. Indeed in the PARTNER B
transcatheter Aortic Valve Replacement (TAVR) trial, only 50% of medically treated patients were alive at 1 year. [16]
In the late 1980s, H. R. Andersen from Denmark did some experimental work in animals with a tri-leaflet stented valve that was inserted in the aortic valve position. This he patented and the patent was bought subsequently by the PVT Company. This was further developed and resulted in the insertion in humans by Cribier of a percutaneous aortic valve in April 2002. The initial approach was through the femoral vein and transeptal puncture and then snaking the valve through the left ventricle into the aortic valve position and deploying the valve there with a balloon inflatable system. Some earlier attempts were made in the United States with this technique but the technique was quickly abandoned because of the complications. [6-17]
In late 2004 and 2005 the transapical approach of insertion of the valve (TA-TAVR) was studied in the animal model by Dewey and Mack and Svensson in sheep and pigs. It became clear that the transapical approach was a good approach for inserting the valves and this resulted in further animal studies in Leipzig with a plan to insert the first transapical aortic valve in Leipzig. This subsequently happened and lead to the expansion and development of the transapical approach. At the same time John Webb and colleagues in Vancouver were also working on the transfemoral (TF-TAVR) arterial approach with a retrograde catheter that was flexible to approach the aortic valve after passing through the aortic arch. The early success of the Vancouver group lead by Webb with both the insertion of the transfemoral and the transapical approach led to further research in the United States on the two new techniques. [6-17] 

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Trans-apical Aortic valve USA experience (pp. 263-274)