My rules of a perfect SAPIEN™ transcatheter aortic valve implantation

Transcatheter aortic valve implantation has been established as an alternative treatment option for those patients with aortic stenosis (AO), who are high risk or unsuitable for surgical aortic valve replacement. Since its introduction, transcatheter aortic valve implantation has been mainly performed either by a percutaneous approach through the femoral arteries or by using a transapical approach via a left-sided mini-thoracotomy. More recently, experience on alternative access routes such as the subclavian artery and the ascending aorta has been reported in a small number of patients. The Edwards SAPIENTM transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) was the first balloon-expandable transcatheter heart valve to receive CE-Mark certification in Europe for transfemoral and transapical aortic valve implantation in 2007/2008. However, it also has been used for transcatheter procedures using access through ascending aorta and subclavian artery. Appropriate patient selection is key for a successful transcatheter aortic valve program and should be in the responsibility of the heart team of interventional cardiologists, cardiac surgeons, cardiac imaging specialists, anesthetists and geriatrists. Their mixture of skills will enable the team to build patient care pathways in which patients are assessed regarding cardiac and non-cardiac comorbidities, the most appropriate type of treatment is jointly agreed, and finally various treatment options are delivered. In this review we highlight the cornerstones of a successful transcatheter aortic valve program using the Edwards SAPIENTM valve. We focus in particular on preoperative diagnostics, patient selection and potential strengths and weaknesses of the various access routes to offer a guideline for future experience.