Current concept on percutaneous aortic valve replacement. Immediate and long-term results

Resumen

Introduction: Transcatheter aortic valve replacement (TAVR) is a novel percutaneous intervention for thetreatment of patients with severe aortic stenosis (AS). Purpose of the Study: provide current datafrom which the indications, risks, benefits, and futuredirections of TAVR are based. Methods: Literaturereview and personal experience derived from theresults of major randomized trial of TAVR vs. surgicalAVR (SAVR) many of them in which I participated arediscussed. Results: The initial PARTNER I trial resultsdemonstrated its value in high-risk patients for SAVR.Subsequent development of new delivery methods anddevices including third generation of TAVR valves (i.e.,Edwards Sapien 3 and Medtronic Evolut R) resulted in areduction of the incidence of procedural complications.Further randomized studies of TAVR vs. SAVR inpatients with severe AS with intermediate surgicalrisk (Partner II and Core-Valve intermediate risk) andthose with low surgical risk (Partner III and Evolutlow risk study) have further support that today TAVRis the standard-of-care procedure for all patients withAS including high, intermediate and low surgical risk.Patients with bicuspid valve anatomy may not get thesame benefits from TAVR as they had been excludedfrom both PARTNER III and Core Valve Low Risk.Finally, the issue remains about the durability of theTAVR valve. Conclusions: TAVR is a breakthroughtechnique that has revolutionized the treatment of ASat the start of this century. TAVR is the standard-ofcareprocedure for all patients with AS including high,intermediate and low surgical risk.

Key words: Aortic stenosis; TVAR vs. SAVR; randomizedtrials of TAVR vs. SAVR in AS; balloon deploymentsapien valve; self-spanding stent TAVR.