Percutaneous valve Technology – University of Leipzig experience – Present and future perspectives (pp. 473-490)
Authors: (David M. Holzhey, Martin Haensig, Friedrich W. Mohr, Ardawan J. Rastan)
Abstract: Since the first transcatheter aortic valve implantation (TAVI) by Alain Cribier in the year 2002 a rapid evolution of the catheter-based therapy to treat severe symptomatic aortic valve stenosis in risk patients has taken place and transapical as well as transfemoral aortic valve implantation has become a routine procedure at many centers [1,16-20]. These new therapeutic approaches for formerly inoperable or very high risk patients have reduced the threshold for treating aortic valve disease far towards higher age and acceptance of significant comorbidities . In parallel, transcatheter technologies have sensitized not only cardiologist but also internal and home doctors to offer these alternative techniques to their old patients with symptomatic aortic stenosis for whom they in former years would have accepted soon death as a natural course. This had led to a significant increase of TAVI procedures worldwide.
Recent studies showed a clear benefit of survival for patients receiving aortic valve implantation compared to optimal medical therapy including aortic valvuloplasty [10,14,21]. These results gave a further boost for both industry and treating physicians to get even more involved in this relatively young field. However, results of TAVI are far from perfect and several questions had to be answered to improve results in the future. One major issue is the right indication for a TAVI and if, whether it should be performed transapically or transfemorally . Second is how to reduce present technical limitations like a high rate of atrioventricular block, a high rate of (minimal to severe) paravalvular leaks and a comparably high rate of at least minor strokes [10,14,21,22]. Whether these drawbacks will influence long term results and quality of life remains unclear at the present state. In this chapter we aim to
summarize our five year experience with TAVI starting with our program in 2006 and to describe lessons we have learned and improvement that were made over the time. Finally we would give some perspectives for the future, especially on new devices which eventually overcome some of the current device limitations.