Transcatheter aortic-valve replacement: a cardiac surgeon and cardiologist team perspective

Transcatheter aortic-valve implantation is a promising new treatment modality for patients with aortic-valve disease, where it may revolutionize the treatment of elderly and high-risk patients.

The two devices currently available, the Edwards Sapien valve and the Medtronic CoreValve system, are presented. With a focus on the CoreValve, we describe the indications, contraindications, procedural technique, cardiologist and heart surgeon team dynamics, and special considerations in patients with concomitant cardiopulmonary disease, peripheral arterial disease, low gradient aortic stenosis, and previous bioprosthetic aortic-valve replacement.

We make a case for judicious team-based adoption of these new technologies and emphasize the need for evidence-based and health economics data. We believe that the above will enable determining the therapeutic niche of these modalities amongst the excellent results of conventional aortic-valve replacement surgery.