Transcutaneous aortic valve implantation: recent advances and future

To present recent experiences and studies on transcutaneous aortic valves implantation for severe aortic stenosis in elderly patients with high-risk profile.

The surgical implantation of aortic valves is a highly efficient and safe procedure but some patients with a high-risk profile are denied surgery. Transcutaneous implantation of aortic valves has evolved as an alternative. Two major systems are available, the Edwards SAPIEN and the Medtronic CoreValve. Selection of patients is based on high age and elevated risk. The risk prediction of the scoring systems should be scrutinized. The anesthesiological approach has partly been determined by the procedural route. General anesthesia is used for transapical approach and transarterial procedures. Local anesthesia and awake or sedated patient can be used for transarterial approach. General anesthesia facilitates the use of perioperative transesophageal echocardiography.

Selection of patients is at present done by criteria such as age above 70-75 years and logistic European system for cardiac operative risk evaluation predicting a risk of death above 20%. The logistic European system for cardiac operative risk evaluation tends to overestimate risk, a fact that should be taken into consideration in patient selection. Trends indicate that the procedure may take a larger part of open surgery for aortic stenosis in the elderly. The consequences for the future of cardiac surgery remain to be seen.