TAVI: from home-made prosthesis to global interventional phenomenon

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Device Technology

Background:

• Surgical aortic valve replacement (AVR) has been the standard treatment for severe aortic stenosis (AS) since the 1960s.
• Percutaneous catheter-mounted valves were explored but not clinically adopted.
• Balloon aortic valvuloplasty offered temporary relief but did not alter disease progression.

Purpose of the Study:

• To review the historical development and evolution of transcatheter aortic valve implantation (TAVI).
• To highlight TAVI's transition from experimental to a widely adopted, less invasive treatment for AS.

Main Methods:

• Historical review of aortic valve intervention techniques.
• Chronological analysis of percutaneous valve technology development.
• Examination of evolving vascular access routes for TAVI.

Main Results:

• TAVI was first performed in 2002, initially via an antegrade transvenous approach.
• Retrograde femoral artery access became the preferred method, establishing TAVI as a reproducible percutaneous procedure.
• Antegrade transapical and retrograde direct aortic approaches were developed for patients with unsuitable femoral access.
• Subclavian access emerged as another feasible alternative route.

Conclusions:

• TAVI has rapidly become a global standard of care for AS treatment within a decade.
• TAVI is an approved, lifesaving, and less invasive alternative to surgical AVR.
• The development of various access routes has expanded TAVI's applicability.