Transcatheter Aortic Valve Replacement

Excerpt

Aortic stenosis (AS) is caused by progressive calficiation of the valve and is the most common cause of left ventricular outflow tract obstruction. Once moderate AS is present, there is a high liklihood of progression to severe AS. Surgical aortic valve replacement has been the standard treatment for patients with severe symptomatic AS. Previously, patients determined to be at high risk for surgery could only be offered diuretics and balloon valvuloplasty which served as palliative treatment and had no effect on long-term outcomes. The development of transcatheter aortic valve replacement (TAVR) has emerged as a lifeline for patients considered to be inoperable providing both improvement in symptoms and statistically significant mortality benefit.

The concept of transcatheter balloon expandable valves was first introduced in the 1980s by a Danish researcher by the name of H. R. Anderson who began testing this idea on pigs. In 2002, Dr. Alain Cribier performed the first successful percutaneous aortic valve replacement on an inoperable patient. The first approval of TAVR for the indication of severe AS in prohibitive risk patients came in 2011. In 2012, the FDA approved TAVR in patients at high surgical risk. In 2015 the indication was expanded to include “valve-in-valve” procedure for failed surgical bioprosthetic valves. In 2016 the FDA approved TAVR valves for use in patients with severe AS at intermediate risk. Following the results of the PARTNER-3 trial published in 2019, the FDA further expanded the indication for TAVR valves to include low risk patients.