Transcatheter aortic valve replacement: US experience

Aortic stenosis is the most frequent valvular heart disease in the USA, and aortic valve replacement remains the only definitive treatment. For patients who cannot have surgery or who are at an increased risk for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) has become an established treatment option. New technological developments in valve design will make TAVR available to an even wider group of patients. This review describes the TAVR procedure and its critical stages.

To ensure that patients with aortic stenosis receive the best treatment option for them, evaluation by a multispecialty heart team is essential. In addition to determining TAVR vs. SAVR, the 'heart team' approach should be used for determining the access site, type, and size of valve, imaging modalities, and the type of anesthetic used for the procedure. Ability to perform TAVR in the cath lab under local anesthesia shortens the duration and lowers the cost of the procedure, and makes it even more attractive.

TAVR is a treatment option for patients who are at an increased risk for SAVR. Evolving technology will likely expand the patient population eligible for this type of treatment in the very near future. Multidisciplinary heart team is essential in improving current techniques and patient selection, as well as evaluating new technologies.