[Transcatheter aortic valve replacement: the future is here!].

Aortic valve replacement (AVR) is the only effective treatment for symptomatic aortic stenosis (AS). In the ideal candidate, the operative mortality associated with AVR is 4%.1 With increasing age, patients with AS acquire other comorbidities that increase their surgical risk to prohibitive levels, limiting their surgical options. It is estimated that at least 30% of the patients with severe AS are not referred for AVR due to their other underlying illnesses.2 The search for a less invasive, less morbid, and equally effective strategy for the treatment of AS started soon after surgical AVR was described. Improvement in valvular prosthetic design increased the valve durability while decreasing the risk of malfunction and thrombosis. Surgical advances have also decreased the perioperative morbidity and mortality to its current rate. However, surgical AVR is still accompanied by the inherent risks of cardiopulmonary bypass and significant rehabilitation after a median sternotomy. These limitations triggered the search for a percutaneous option for the treatment of AS. Balloon aortic valvuloplasty (BAV) emerged as an effective way of postponing AVR in patients with congenital AS. However its application in patients with calcific/degenerative AS yielded a high rate of early restenosis, complications, and no increase in survival.3 Suboptimal results with BAV prompted a re-evaluation of the percutaneous options and led to the development of transcatheter AVR (TAVR). This concept consists of replacing the native aortic valve with a stent mounted prosthesis which is placed percutaneously through the femoral artery, vein, or directly through the left ventricle. After significant animal experimentation, the first human TAVR was performed by us in Rouen, France in 2002.4 TAVR opened the possibility for treating patients who had been left untreated as it was believed that their operative mortality outweighed the benefits of traditional AVR. Initial reports using a balloon expandable bioprosthesis (Percutaneous Valve Technology [PVT] New-Jersey, Transcatheter Aortic Valve Replacement: The Future Is Here!