Transcatheter aortic valve replacement

Abstract

Aortic stenosis is the most frequently acquired heart disease, and theprevalence is rising because of the aging population. If the disease is left untreated, survival in symptomatic patients averages only 2 to 3 years. Surgical aortic valvereplacement is the only defi nitive treatment, yet 30% of elderly patients are notconsidered candidates because the presence of comorbidities makes the risk of sternotomy and cardiopulmonary bypass prohibitively high. Transcatheter aortic valvereplacement (TAVR) is an innovative,high-tech, less invasive alternative. The procedure is usually performed using general anesthesia and a multidisciplinary team from interventional cardiology and cardiothoracic surgery in a "hybrid" operatingenvironment with advanced imaging capabilities. There are 2 major catheter-based approaches to the aortic valve: retrograde percutaneous through the femoral artery andaorta or direct antegrade through a thoracotomy and the left ventricular apex.Apnea and rapid ventricular pacing are used to interrupt cardiac ejection during balloon valvuloplasty and prosthesis implantation. The most signifi cant complications include vascular damage, stroke, paravalvular aortic insuffi ciency, and heartblock. Outcomes studies comparing TAVR with medicalmanagement demonstrate improved patient survival, functional status, and quality of life. Currently TAVR is considered the treatment of choice for patients who are not surgical candidates and isa proven alternative for high-risk surgical candidates.